Healthcare Provider Details

I. General information

NPI: 1770851750
Provider Name (Legal Business Name): MEGHAN ANN FARRELL PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 12/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1255 PEARL ST
EUGENE OR
97401-3570
US

IV. Provider business mailing address

1255 PEARL ST
EUGENE OR
97401-3570
US

V. Phone/Fax

Practice location:
  • Phone: 541-687-6983
  • Fax:
Mailing address:
  • Phone: 541-687-6983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number178665
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201400922NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNURU1271
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: