Healthcare Provider Details

I. General information

NPI: 1043223795
Provider Name (Legal Business Name): SALLY YVONNE FARR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1560 OPESSUMTOWN PIKE STE 18
FREDERICK MD
21702
US

IV. Provider business mailing address

330 N HOWARD ST
BALTIMORE MD
21201
US

V. Phone/Fax

Practice location:
  • Phone: 301-662-7171
  • Fax: 301-620-9443
Mailing address:
  • Phone: 410-576-1400
  • Fax: 410-576-7600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR129867
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: