Provider Demographics
NPI:1043765589
Name:FARQUHARSON, ANGELLAE (LPN)
Entity Type:Individual
Prefix:
First Name:ANGELLAE
Middle Name:
Last Name:FARQUHARSON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CORTLANDT ST
Mailing Address - Street 2:APT 2
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-2705
Mailing Address - Country:US
Mailing Address - Phone:917-569-9450
Mailing Address - Fax:
Practice Address - Street 1:15 CORTLANDT ST
Practice Address - Street 2:APT 2
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2705
Practice Address - Country:US
Practice Address - Phone:917-569-9450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY323606164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse