Provider Demographics
NPI:1497364624
Name:FARRA, SAMANTHA
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:FARRA
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 1:428 FARRA LN
Mailing Address - Street 2:
Mailing Address - City:SANDYVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25275-6523
Mailing Address - Country:US
Mailing Address - Phone:304-273-2846
Mailing Address - Fax:
Practice Address - Street 1:428 FARRA LN
Practice Address - Street 2:
Practice Address - City:SANDYVILLE
Practice Address - State:WV
Practice Address - Zip Code:25275-6523
Practice Address - Country:US
Practice Address - Phone:304-273-2846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant