MEDICARE: JEANNINE FARRELLY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1780831982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNINE FARRELLY

Provider Business Mailing Address
First Line	:	601 N MARKET BLVD
Second Line	:	SUITE 350
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1200
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3440 VIKING DR
Second Line	:	SUITE 114
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-2844
Country	:	US
Telephone Number	:	916-364-8395
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	09/12/2008

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