Provider Demographics
NPI:1316722374
Name:FARMER, ELLEN (RN)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-1519
Mailing Address - Country:US
Mailing Address - Phone:781-640-7049
Mailing Address - Fax:
Practice Address - Street 1:103 GROVE ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-1519
Practice Address - Country:US
Practice Address - Phone:781-640-7049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156FX1101X
MARN280501163W00000X, 163WM0705X, 163WP2201X, 163WC0400X, 163WX1100X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No156FX1101XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic Assistant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WX1100XNursing Service ProvidersRegistered NurseOphthalmic