1215197033 NPI number — CHRISTINE LYNN FARRELL MSN FNP-C

Table of content: CHRISTINE LYNN FARRELL MSN FNP-C (NPI 1215197033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215197033 NPI number — CHRISTINE LYNN FARRELL MSN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
CHRISTINE
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215197033
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3180 WILLOW LANE
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
WESTLAKE VILLAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91361
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-494-8520
Provider Business Mailing Address Fax Number:
805-557-0196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3180 WILLOW LN
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
THOUSAND OAKS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91361-4941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-494-8520
Provider Business Practice Location Address Fax Number:
805-557-0196
Provider Enumeration Date:
06/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  NP9006 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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