Provider Demographics
NPI:1477255925
Name:FARRELL, JOANNA RUYUN
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:RUYUN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 HARRISON AVE # M&V510
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02111-1817
Mailing Address - Country:US
Mailing Address - Phone:978-844-6834
Mailing Address - Fax:
Practice Address - Street 1:136 HARRISON AVE # M&V510
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1817
Practice Address - Country:US
Practice Address - Phone:617-636-0405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program