MEDICARE: MRS. CARLA RAE FARNWORTH NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	APN001060	NV
2	363LF0000X	Family Nurse Practitioner	APRN001060	NV

General Provider Information

NPI Number	:	1093804213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CARLA RAE FARNWORTH NP

Provider Business Mailing Address
First Line	:	300 CAMBRIDGE CT
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-7675
Country	:	US
Telephone Number	:	758-851-5207
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 CAMBRIDGE CT
Second Line	:
City	:	CARSON CITY
State	:	NV
Zip	:	89701-7675
Country	:	US
Telephone Number	:	775-885-1520
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/13/2019

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