Provider Demographics
NPI:1134830136
Name:FARWELL, TANIA
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:FARWELL
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 1:2500 ONYX DR
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-2769
Mailing Address - Country:US
Mailing Address - Phone:612-710-4132
Mailing Address - Fax:
Practice Address - Street 1:2500 ONYX DR
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-2769
Practice Address - Country:US
Practice Address - Phone:612-710-4132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider