Healthcare Provider Details

I. General information

NPI: 1588626220
Provider Name (Legal Business Name): PAIGE FARRELL PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 WILLAMETTE ST
EUGENE OR
97401-3568
US

IV. Provider business mailing address

268 S PACIFIC HWY
TALENT OR
97540-6649
US

V. Phone/Fax

Practice location:
  • Phone: 541-984-4301
  • Fax:
Mailing address:
  • Phone: 541-535-5523
  • Fax: 541-512-8761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00564
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: