Provider Demographics
NPI:1164977203
Name:FARRELLY, JENNIFER (RN)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:FARRELLY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W MARKET ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GEORGETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19947-1492
Mailing Address - Country:US
Mailing Address - Phone:302-854-0626
Mailing Address - Fax:302-854-0628
Practice Address - Street 1:5 W MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1492
Practice Address - Country:US
Practice Address - Phone:302-854-0626
Practice Address - Fax:302-854-0628
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0048361163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health