Provider Demographics
NPI:1881908325
Name:FARRELL, HEIDI ANN (PA-C)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:ANN
Last Name:FARRELL
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 1:21903 W KNOLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-7038
Mailing Address - Country:US
Mailing Address - Phone:708-486-2600
Mailing Address - Fax:
Practice Address - Street 1:675 W NORTH AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:MELROSE PARK
Practice Address - State:IL
Practice Address - Zip Code:60160-1634
Practice Address - Country:US
Practice Address - Phone:708-486-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant