Individual
COURTNEY FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-4261
(801) 662-4285
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
363LN0000X
Neonatal Nurse Practitioner
Primary
12864933-4405
UT
363LP0200X
Pediatric Nurse Practitioner
382637
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04539382
—
NY
Enumeration date
07/14/2016
Last updated
02/02/2023
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