Provider Demographics
NPI:1184257115
Name:FARRELL, JOANNA RAE (CRNP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:RAE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 NE 32ND AVE APT 425
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3455
Mailing Address - Country:US
Mailing Address - Phone:345-595-5456
Mailing Address - Fax:
Practice Address - Street 1:1650 NE 32ND AVE APT 425
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3455
Practice Address - Country:US
Practice Address - Phone:345-595-5456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201909575NP-PP363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology