Healthcare Provider Details

I. General information

NPI: 1710595517
Provider Name (Legal Business Name): LISA FARINELLI RN, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 BAYVIEW BLDV
BALTIMORE MD
21224
US

IV. Provider business mailing address

251 BAYVIEW BLVD RM 1A840
BALTIMORE MD
21224-2816
US

V. Phone/Fax

Practice location:
  • Phone: 301-640-1924
  • Fax:
Mailing address:
  • Phone: 301-640-1924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR149835
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: