MEDICARE: ADAM MATTHEW FARNUM 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	363LF0000X	Family Nurse Practitioner	4704314779	MI

General Provider Information

NPI Number	:	1871175638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM MATTHEW FARNUM NP

Provider Business Mailing Address
First Line	:	3955 PATIENT CARE DR STE A
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48911-4271
Country	:	US
Telephone Number	:	517-374-7600
Fax Number	:	855-495-5457

Provider Business Practice Location Address
First Line	:	1003 E MOUNT HOPE AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48910-1822
Country	:	US
Telephone Number	:	517-853-3704
Fax Number	:	855-501-6733

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

Provider Enumeration Date	:	04/22/2021
Last Update Date	:	08/29/2024

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