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General NPI Number Information
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NPI Number | 1275613960
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Entity Type | Individual
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Provider Name | STEFAN BRICE FARRELL CNS, MSN
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Gender | Male
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 01/23/2019
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Provider Practice Location Address
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Address Line | 2251 N 32ND ST LOT 16
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City | MESA
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State | AZ
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Zip | 85213-2426
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Country | US
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Telephone | 480-844-9817
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Fax | 480-461-9195
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Provider Business Mailing Address
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Address Line | PO BOX 30361
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City | MESA
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State | AZ
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Zip | 85275-0361
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Country | US
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Telephone | 480-844-9817
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Fax | 480-461-9195
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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 | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | RN 085383
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 364SP2800X
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Taxonomy Name | Perioperative Clinical Nurse Specialist
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License Number | RN 085383
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License Number State | AZ
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