Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 5007151 | NC |
N | 363L00000X | Nurse Practitioner | A153963 | IA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 5007151 | NC |
Y | 363LA2100X | Nurse Practitioner - Acute Care | A153963 | IA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | A153963 | IA |
NPI | 1043611023 |
---|---|
Provider Name | Alex Scott Farrell |
First Address | Mason City, IA 50401-5489 |
Second Address | Mason City, IA 50401-2800 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 27/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5007151 | LICENSES (01) | NC |
MF3745289 | (02) | NC |
MF3745289 | DEA (01) | NC |