Provider Demographics
NPI:1275508632
Name:FARRELL, TRISHA LYNN (CNM, WHNP, MS)
Entity Type:Individual
Prefix:MRS
First Name:TRISHA
Middle Name:LYNN
Last Name:FARRELL
Suffix:
Gender:F
Credentials:CNM, WHNP, MS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1020 11TH AVE
Mailing Address - Street 2:USS RED ROVER BUILDING 1523
Mailing Address - City:GREAT LAKES
Mailing Address - State:IL
Mailing Address - Zip Code:60088-3102
Mailing Address - Country:US
Mailing Address - Phone:847-688-5568
Mailing Address - Fax:
Practice Address - Street 1:955 S BAILEY AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-6743
Practice Address - Country:US
Practice Address - Phone:269-639-2720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704176647363LW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health