Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 15250 | CA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 15250 | CA |
NPI | 1073684270 |
---|---|
Provider Name | Lawanna Gale Farrell |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93721-1324 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2006 |
Last Update Date | 28/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PA17697 | (05) | CA |
Q31124 | (02) | CA |