Provider Demographics
NPI:1427281401
Name:FARNUM, HEIDI MARIE (APRN-CRNA)
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:MARIE
Last Name:FARNUM
Suffix:
Gender:F
Credentials:APRN-CRNA
Other - Prefix:MISS
Other - First Name:HEIDI
Other - Middle Name:MARIE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-NP
Mailing Address - Street 1:1316 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLARION
Mailing Address - State:IA
Mailing Address - Zip Code:50525-2019
Mailing Address - Country:US
Mailing Address - Phone:515-532-2811
Mailing Address - Fax:515-532-9245
Practice Address - Street 1:1316 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:515-532-9245
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111068363L00000X
NE101495367500000X
IAD153765367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner