Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 382637 | NY |
NPI | 1023461068 |
---|---|
Provider Name | Courtney Farrell |
First Address | Rochester, NY 14626-4122 |
Second Address | Rochester, NY 14626-4122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2016 |
Last Update Date | 30/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04539382 | (05) | NY |