Provider Demographics
NPI:1255800785
Name:FARRAR, VONDA LYNN (MSN, RN, NP-C)
Entity type:Individual
Prefix:MRS
First Name:VONDA
Middle Name:LYNN
Last Name:FARRAR
Suffix:
Gender:F
Credentials:MSN, RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1918 DE WINTON PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5021
Mailing Address - Country:US
Mailing Address - Phone:205-994-1984
Mailing Address - Fax:877-789-3032
Practice Address - Street 1:1918 DE WINTON PL
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5021
Practice Address - Country:US
Practice Address - Phone:205-994-1984
Practice Address - Fax:877-789-3032
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF02180637363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner