Provider Demographics
NPI:1558589044
Name:FARRELL, CLARE A (NP)
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:A
Last Name:FARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:NY
Mailing Address - Zip Code:11780-2205
Mailing Address - Country:US
Mailing Address - Phone:631-862-7062
Mailing Address - Fax:631-862-7114
Practice Address - Street 1:403 LAKE AVE
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:NY
Practice Address - Zip Code:11780-2205
Practice Address - Country:US
Practice Address - Phone:631-862-7062
Practice Address - Fax:631-862-7114
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334560-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily