Healthcare Provider Details

I. General information

NPI: 1528043502
Provider Name (Legal Business Name): MICHAEL F. FARRELL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 NYS ROUTE 49
BERNHARDS BAY NY
13028
US

IV. Provider business mailing address

499 NYS ROUTE 49 PO BOX 174
BERNHARDS BAY NY
13028
US

V. Phone/Fax

Practice location:
  • Phone: 315-391-0200
  • Fax:
Mailing address:
  • Phone: 315-391-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number134530
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number246302
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP3373282
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number692023
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN352893L
License Number StatePA
# 6
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2515
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number163598
License Number StateNC
# 8
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number464345-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: