Provider Demographics
NPI:1598194714
Name:FARRELL, JEANNE NICOLE
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:NICOLE
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANNE
Other - Middle Name:NICOLE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:98 LAKEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06073-2312
Mailing Address - Country:US
Mailing Address - Phone:860-633-9223
Mailing Address - Fax:
Practice Address - Street 1:98 LAKEWOOD CIR
Practice Address - Street 2:
Practice Address - City:SOUTH GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06073-2312
Practice Address - Country:US
Practice Address - Phone:860-633-9223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT110426163WP0200X, 163WP0807X, 163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No163WS0200XNursing Service ProvidersRegistered NurseSchool