Provider Demographics
NPI:1073699666
Name:FARRELL, VIRGINIA (CNM)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 2ND PLACE
Mailing Address - Street 2:APT #1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3403
Mailing Address - Country:US
Mailing Address - Phone:718-813-2250
Mailing Address - Fax:
Practice Address - Street 1:28 2ND PLACE
Practice Address - Street 2:APT #1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3403
Practice Address - Country:US
Practice Address - Phone:718-813-2250
Practice Address - Fax:718-918-4469
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001068176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02335591Medicaid