Provider Demographics
NPI:1659198547
Name:FARRELL, BRENDA R (RN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:FARRELL
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4050 PIEDMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9458
Mailing Address - Country:US
Mailing Address - Phone:336-289-8648
Mailing Address - Fax:
Practice Address - Street 1:4050 PIEDMONT PKWY
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-9458
Practice Address - Country:US
Practice Address - Phone:336-289-8648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA782259163W00000X
NV859374163W00000X
OR10000404163W00000X
PARN764726163W00000X
NY884747163W00000X
TX961949163W00000X
MN2508062163W00000X
CT201256163W00000X
IL041533147163W00000X
MARN2372804163W00000X
MI4704396160163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse