Provider Demographics
NPI:1598778078
Name:STEFAN FARRELL RNFA, PLLC
Entity Type:Organization
Organization Name:STEFAN FARRELL RNFA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEFAN
Authorized Official - Middle Name:BRICE
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:CNS, CRNFA
Authorized Official - Phone:480-844-9817
Mailing Address - Street 1:PO BOX 30361
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85275-0361
Mailing Address - Country:US
Mailing Address - Phone:480-844-9817
Mailing Address - Fax:480-461-9195
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2612
Practice Address - Country:US
Practice Address - Phone:480-844-9817
Practice Address - Fax:480-461-9195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperativeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ 0167830OtherBC/BS
189762400OtherUS LABOR
7562119OtherCIGNA
890001034OtherRAILROAD
AZ1Z4109OtherHEALTHNET
AZ479073Medicaid
AZ1Z4109OtherHEALTHNET