Provider Demographics
NPI:1316002108
Name:FARLEY, JUDINE LYNN (RN, LAC, MSTCM)
Entity Type:Individual
Prefix:
First Name:JUDINE
Middle Name:LYNN
Last Name:FARLEY
Suffix:
Gender:F
Credentials:RN, LAC, MSTCM
Other - Prefix:
Other - First Name:JUDINE
Other - Middle Name:LYNN
Other - Last Name:FARLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, LAC
Mailing Address - Street 1:6223 KILMER LOOP
Mailing Address - Street 2:#203
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80403
Mailing Address - Country:US
Mailing Address - Phone:720-201-0658
Mailing Address - Fax:
Practice Address - Street 1:1019 8TH STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401
Practice Address - Country:US
Practice Address - Phone:720-201-0658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO88543163W00000X
CO775171100000X
COCO#775171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1316002108OtherLAC