Provider Demographics
NPI:1760775936
Name:FARRELL, MARY BRIGID (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BRIGID
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:3100 SPRING FOREST RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-2880
Mailing Address - Country:US
Mailing Address - Phone:919-882-0795
Mailing Address - Fax:919-873-9821
Practice Address - Street 1:4420 LAKE BOONE TRAIL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-2880
Practice Address - Country:US
Practice Address - Phone:919-873-9533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-22
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88338367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered