Healthcare Provider Details

I. General information

NPI: 1538052766
Provider Name (Legal Business Name): MICHELLE MARIE FARRINGTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE MARIE WATSON

II. Dates (important events)

Enumeration Date: 05/28/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 SONATINA DR
HENDERSON NV
89052-5520
US

IV. Provider business mailing address

1208 SONATINA DR
HENDERSON NV
89052-5520
US

V. Phone/Fax

Practice location:
  • Phone: 609-731-1454
  • Fax: 609-731-1454
Mailing address:
  • Phone: 609-731-1454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number841034
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: