MEDICARE: STEFAN FARRELL RNFA, PLLC

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	364SP2800X	Perioperative Clinical Nurse Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ 0167830	OTHER	AZ	BC/BS
2	189762400	OTHER		US LABOR
3	7562119	OTHER		CIGNA
4	890001034	OTHER		RAILROAD
5	1Z4109	OTHER	AZ	HEALTHNET
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598778078
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEFAN FARRELL RNFA, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 30361
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85275-0361
Country	:	US
Telephone Number	:	480-844-9817
Fax Number	:	480-461-9195

Provider Business Practice Location Address
First Line	:	1111 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85006-2612
Country	:	US
Telephone Number	:	480-844-9817
Fax Number	:	480-461-9195

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEFAN BRICE FARRELL
Credential	:	CNS, CRNFA
Telephone Number	:	480-844-9817

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	11/27/2012

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