Provider Demographics
NPI:1417292574
Name:FARRELL, ISALINE DENISE (RN)
Entity Type:Individual
Prefix:MISS
First Name:ISALINE
Middle Name:DENISE
Last Name:FARRELL
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 1:4416 MONTICELLO AVE
Mailing Address - Street 2:PH
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-1138
Mailing Address - Country:US
Mailing Address - Phone:646-421-8211
Mailing Address - Fax:
Practice Address - Street 1:4416 MONTICELLO AVE
Practice Address - Street 2:PH
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-1138
Practice Address - Country:US
Practice Address - Phone:646-421-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY654800-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse