Provider Demographics
NPI:1386350171
Name:FARRELL, ELLEN OLIVIA (PA-C)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:OLIVIA
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 1:1301 S CLIFF AVE STE 506
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-1023
Mailing Address - Country:US
Mailing Address - Phone:605-504-0100
Mailing Address - Fax:605-504-0159
Practice Address - Street 1:1301 S CLIFF AVE STE 506
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1023
Practice Address - Country:US
Practice Address - Phone:605-504-0100
Practice Address - Fax:605-504-0159
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2024-02-09
Deactivation Date:2023-01-25
Deactivation Code:
Reactivation Date:2023-02-01
Provider Licenses
StateLicense IDTaxonomies
SD1420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant