Healthcare Provider Details

I. General information

NPI: 1083991418
Provider Name (Legal Business Name): GINA A FARRELL-ROGERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2011
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 HARRISON ST
SYRACUSE NY
13210-2395
US

IV. Provider business mailing address

725 HARRISON ST
SYRACUSE NY
13210-2395
US

V. Phone/Fax

Practice location:
  • Phone: 315-435-4145
  • Fax: 315-435-4859
Mailing address:
  • Phone: 315-435-4145
  • Fax: 315-435-4859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number510229-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: