MEDICARE: MS. ELLEN REILLEY FARRELL CRNP

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	363L00000X	Nurse Practitioner	R086637	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518025824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN REILLEY FARRELL CRNP

Provider Business Mailing Address
First Line	:	4579 WILLOWS RD
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-4217
Country	:	US
Telephone Number	:	443-271-0688
Fax Number	:	443-271-0688

Provider Business Practice Location Address
First Line	:	4579 WILLOWS RD
Second Line	:
City	:	CHESAPEAKE BEACH
State	:	MD
Zip	:	20732-4217
Country	:	US
Telephone Number	:	443-271-0688
Fax Number	:	443-271-0688

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	09/10/2021

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