Provider Demographics
NPI:1346856721
Name:DETOLL, FARREN DODSON (FNP)
Entity Type:Individual
Prefix:
First Name:FARREN
Middle Name:DODSON
Last Name:DETOLL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:FARREN
Other - Middle Name:DODSON
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9007
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22906-9007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16268 BENNETT RD
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4630
Practice Address - Country:US
Practice Address - Phone:540-825-6263
Practice Address - Fax:540-825-4911
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001245519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily