Provider Demographics
NPI:1972581270
Name:FARRELL, ELLEN (NP)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:FRANKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23354-0009
Mailing Address - Country:US
Mailing Address - Phone:757-442-4819
Mailing Address - Fax:757-442-9505
Practice Address - Street 1:9159 FRANKTOWN RD
Practice Address - Street 2:
Practice Address - City:FRANKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23354
Practice Address - Country:US
Practice Address - Phone:757-442-4819
Practice Address - Fax:757-442-9505
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024076861363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics