Provider Demographics
NPI:1508634767
Name:GAINEY, FARRAH DAWN (LVN)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:DAWN
Last Name:GAINEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 LOOKOUT CT
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-8611
Mailing Address - Country:US
Mailing Address - Phone:951-203-1649
Mailing Address - Fax:
Practice Address - Street 1:30971 SILVER LEAF DR
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2952
Practice Address - Country:US
Practice Address - Phone:949-503-1705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA246210164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse