1851933162 NPI number — MRS. EVELYN JEANNE MCFARREN RN

Table of content: MRS. EVELYN JEANNE MCFARREN RN (NPI 1851933162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851933162 NPI number — MRS. EVELYN JEANNE MCFARREN RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCFARREN
Provider First Name:
EVELYN
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ILSLEY
Provider Other First Name:
EVELYN
Provider Other Middle Name:
JEANNE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1851933162
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 148
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENSSELAER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12144-0148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-449-1142
Provider Business Mailing Address Fax Number:
518-449-1320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 WILSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12803-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-207-8861
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/09/2019

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: 163WH0200X , with the licence number:  737369 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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