Provider Demographics
NPI:1104505940
Name:FARRELL, CORRINE (LPN)
Entity type:Individual
Prefix:
First Name:CORRINE
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1268 N NEWKIRK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-4527
Mailing Address - Country:US
Mailing Address - Phone:215-715-1942
Mailing Address - Fax:
Practice Address - Street 1:1268 N NEWKIRK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-4527
Practice Address - Country:US
Practice Address - Phone:215-715-1942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN317384164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse