MEDICARE: FARRAH HALVORSON

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	163WH0200X	Home Health Registered Nurse	2467533	MN

General Provider Information

NPI Number	:	1952140824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FARRAH HALVORSON

Provider Business Mailing Address
First Line	:	807 CLOQUET AVE STE 200
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1660
Country	:	US
Telephone Number	:	218-879-2035
Fax Number	:	218-879-3523

Provider Business Practice Location Address
First Line	:	807 CLOQUET AVE STE 200
Second Line	:
City	:	CLOQUET
State	:	MN
Zip	:	55720-1660
Country	:	US
Telephone Number	:	218-879-2035
Fax Number	:	218-879-3523

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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