Provider Demographics
NPI:1639719404
Name:FARRELL, NATALIE
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 PROSPERITY AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4339
Mailing Address - Country:US
Mailing Address - Phone:703-698-2431
Mailing Address - Fax:571-665-6878
Practice Address - Street 1:2700 PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4339
Practice Address - Country:US
Practice Address - Phone:703-698-2431
Practice Address - Fax:571-665-6878
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178594363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily