Provider Demographics
NPI:1518025824
Name:FARRELL, ELLEN REILLEY (CRNP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:REILLEY
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4579 WILLOWS RD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE BEACH
Mailing Address - State:MD
Mailing Address - Zip Code:20732-4217
Mailing Address - Country:US
Mailing Address - Phone:443-271-0688
Mailing Address - Fax:443-271-0688
Practice Address - Street 1:4579 WILLOWS RD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE BEACH
Practice Address - State:MD
Practice Address - Zip Code:20732-4217
Practice Address - Country:US
Practice Address - Phone:443-271-0688
Practice Address - Fax:443-271-0688
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR086637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404250600Medicaid
DCP31948Medicare UPIN
DC00A784G60Medicare PIN
MD404250600Medicaid