Provider Demographics
NPI:1790137644
Name:FARREN, CHRISTINE ANNE
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:FARREN
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 1:1049 AMBROSIA DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-8011
Mailing Address - Country:US
Mailing Address - Phone:215-593-7018
Mailing Address - Fax:
Practice Address - Street 1:2500 ENGLISH CREEK AVE
Practice Address - Street 2:BLDG 400, 2ND FL
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234
Practice Address - Country:US
Practice Address - Phone:609-677-7777
Practice Address - Fax:609-677-7277
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-04
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016881363LF0000X
SC20585363LF0000X
SC223614390200000X
NVAPRN002462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program