=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487652772
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EYDIE A FARROW APNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2005
-----------------------------------------------------
Last Update Date | 06/03/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 4TH AVENUE
-----------------------------------------------------
City | SHELL LAKE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-468-7833
-----------------------------------------------------
Fax | 715-468-7839
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 4TH AVENUE
-----------------------------------------------------
City | SHELL LAKE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-468-7833
-----------------------------------------------------
Fax | 715-468-7839
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1707-33
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 1707
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------