Provider Demographics
NPI:1356699391
Name:FARRELL, NICOLE C (LPN)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:C
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-2200
Mailing Address - Country:US
Mailing Address - Phone:419-245-8723
Mailing Address - Fax:
Practice Address - Street 1:1253 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-2200
Practice Address - Country:US
Practice Address - Phone:419-245-8723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-23
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 112195164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse