Provider Demographics
NPI:1790527497
Name:FARAH, LENA GRACE (PA-C)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:GRACE
Last Name:FARAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-8446
Mailing Address - Country:US
Mailing Address - Phone:518-742-7745
Mailing Address - Fax:
Practice Address - Street 1:500 E 51ST ST STE 1
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-2494
Practice Address - Country:US
Practice Address - Phone:518-742-7745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical