Healthcare Provider Details

I. General information

NPI: 1710082383
Provider Name (Legal Business Name): ANN MARIE FARRELL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3461 CIVIC CENTER BLVD
PHILA PA
19104-4302
US

IV. Provider business mailing address

4509 RITCHIE ST
PHILADELPHIA PA
19127-1244
US

V. Phone/Fax

Practice location:
  • Phone: 215-823-5800
  • Fax:
Mailing address:
  • Phone: 215-823-5800
  • Fax: 215-823-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberVP005062C
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: