Provider Demographics
NPI:1669402079
Name:FARRELL, ROMAYNE ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ROMAYNE
Middle Name:ELIZABETH
Last Name:FARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROMAYNE
Other - Middle Name:ELIZABETH
Other - Last Name:GUSTAFSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15620 HEALDSBURG AVENUE
Mailing Address - Street 2:
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448
Mailing Address - Country:US
Mailing Address - Phone:707-473-4531
Mailing Address - Fax:707-473-4559
Practice Address - Street 1:1400 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928
Practice Address - Country:US
Practice Address - Phone:707-586-0440
Practice Address - Fax:707-586-1444
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2962363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner