Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LP0200X | Nurse Practitioner - Pediatrics | 26NJ00093600 | NJ |
Y | 363LP0200X | Nurse Practitioner - Pediatrics | AP121065 | TX |
N | 363LP0200X | Nurse Practitioner - Pediatrics | SP008101 | PA |
NPI | 1023152030 |
---|---|
Provider Name | Brandi Dennison Farrell |
First Address | San Antonio, TX 78229-3901 |
Second Address | San Antonio, TX 78229-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2007 |
Last Update Date | 09/11/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288036101 | (05) | TX |
288036102 | CSHCN (01) | TX |
288036105 | (05) | TX |