1346712692 NPI number — FRENZELOR ELIZABETH FARROW EXECUTIVE DIRECTOR

Table of content: FRENZELOR ELIZABETH FARROW EXECUTIVE DIRECTOR (NPI 1346712692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346712692 NPI number — FRENZELOR ELIZABETH FARROW EXECUTIVE DIRECTOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARROW
Provider First Name:
FRENZELOR
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EXECUTIVE DIRECTOR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARROW
Provider Other First Name:
ZEL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346712692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1406 TUNBRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24501-5318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-229-2770
Provider Business Mailing Address Fax Number:
434-385-5241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1406 TUNBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24501-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-229-2770
Provider Business Practice Location Address Fax Number:
434-385-5241
Provider Enumeration Date:
12/27/2018

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: 253Z00000X , with the licence number:  3173-08-011 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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