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General NPI Number Information
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NPI Number | 1134637853
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Entity Type | Individual
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Provider Name | ELIZABETH MARIE FARRELL PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 03/22/2022
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Provider Practice Location Address
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Address Line | 1020 SW TAYLOR ST STE 700
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City | PORTLAND
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State | OR
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Zip | 97205-2512
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Country | US
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Telephone | 503-956-9264
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Fax | 206-338-9984
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Provider Business Mailing Address
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Address Line | 3439 NE SANDY BLVD STE 262
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City | PORTLAND
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State | OR
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Zip | 97232-1959
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Country | US
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Telephone | 503-956-9264
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Fax | 206-338-9984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 201709598NP-PP
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License Number State | OR
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