Provider Demographics
NPI:1528043502
Name:FARRELL, MICHAEL F (CRNA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
Last Name:FARRELL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:499 NYS ROUTE 49
Mailing Address - Street 2:PO BOX 174
Mailing Address - City:BERNHARDS BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13028
Mailing Address - Country:US
Mailing Address - Phone:315-391-0200
Mailing Address - Fax:
Practice Address - Street 1:499 NYS ROUTE 49
Practice Address - Street 2:
Practice Address - City:BERNHARDS BAY
Practice Address - State:NY
Practice Address - Zip Code:13028
Practice Address - Country:US
Practice Address - Phone:315-391-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI134530367500000X
MA246302367500000X
FLARNP3373282367500000X
TX692023367500000X
PARN352893L367500000X
CA2515367500000X
NC163598367500000X
NY464345-1367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
048836OtherCRNA RECERTIFICATION CARD
NYRB2373Medicare PIN
WIS44049Medicare UPIN