Provider Demographics
NPI:1740679752
Name:FERRELL, JOLINDA (APNP)
Entity type:Individual
Prefix:
First Name:JOLINDA
Middle Name:
Last Name:FERRELL
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 EDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54703-0810
Mailing Address - Country:US
Mailing Address - Phone:715-379-4623
Mailing Address - Fax:
Practice Address - Street 1:1291 CRAIG AVE
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-5704
Practice Address - Country:US
Practice Address - Phone:707-263-6382
Practice Address - Fax:707-263-7213
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-14
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23611363LA2200X
WI5700-33363LA2200X
AZAP5014363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health