Provider Demographics
NPI:1518381201
Name:LATHEN-FARWELL, GAIL
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:
Last Name:LATHEN-FARWELL
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 1:343 S KIRKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4015
Mailing Address - Country:US
Mailing Address - Phone:314-452-6490
Mailing Address - Fax:314-206-3477
Practice Address - Street 1:343 S KIRKWOOD RD
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4015
Practice Address - Country:US
Practice Address - Phone:314-452-6490
Practice Address - Fax:314-206-3477
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110682163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse