Provider Demographics
NPI:1164658373
Name:FARLEY, GERALDINE (NP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:FARLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COOPER ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3398
Mailing Address - Country:US
Mailing Address - Phone:800-379-1600
Mailing Address - Fax:866-761-5657
Practice Address - Street 1:103 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2211
Practice Address - Country:US
Practice Address - Phone:877-935-0055
Practice Address - Fax:877-467-1700
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704141449363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner