Provider Demographics
NPI:1013936558
Name:LOUIS, FARAH OCTAVIE (RN)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:OCTAVIE
Last Name:LOUIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:FARAH
Other - Middle Name:OCTAVIE
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16 PETIPAS LN
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4917
Mailing Address - Country:US
Mailing Address - Phone:781-961-5922
Mailing Address - Fax:
Practice Address - Street 1:16 PETIPAS LN
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4917
Practice Address - Country:US
Practice Address - Phone:781-961-5922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237158163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse