Provider Demographics
NPI:1124234158
Name:MCFARLIN, JENNY DARA
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:DARA
Last Name:MCFARLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7362 W PARKS HWY # 823
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-9132
Mailing Address - Country:US
Mailing Address - Phone:907-357-8049
Mailing Address - Fax:907-357-8049
Practice Address - Street 1:7362 W PARKS HWY # 823
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-9132
Practice Address - Country:US
Practice Address - Phone:907-357-8049
Practice Address - Fax:907-357-8049
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK100087376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKRL 8787 & HC8787Medicaid