Healthcare Provider Details

I. General information

NPI: 1235503475
Provider Name (Legal Business Name): SEAN J FARLEY RN, BSN, CCRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2015
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORTHEAST DR
BANGOR ME
04401-4332
US

IV. Provider business mailing address

43 WHITING HILL SUITE 300
BREWER ME
04412
US

V. Phone/Fax

Practice location:
  • Phone: 207-275-3800
  • Fax:
Mailing address:
  • Phone: 207-973-5293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number545463
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number26NR11263800
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCNP161216
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: