Provider Demographics
NPI:1316948730
Name:FARROW, SUSAN B (FNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:FARROW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:109 HWY 51 NORTH
Mailing Address - Street 2:PO BOX 349
Mailing Address - City:MARBLE HILL
Mailing Address - State:MO
Mailing Address - Zip Code:63764
Mailing Address - Country:US
Mailing Address - Phone:573-238-2725
Mailing Address - Fax:573-238-3795
Practice Address - Street 1:408 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5725
Practice Address - Country:US
Practice Address - Phone:573-339-1196
Practice Address - Fax:573-339-7945
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO090163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00016805OtherRAILROAD MEDICARE
MOP75085Medicare UPIN