Individual
LAWANNA GALE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, PA-C, MSN
Contact information
Practice address
2823 FRESNO ST, FRESNO, CA 93721-1324
(559) 499-6440
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 443-2682
(559) 443-2681
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
384314
CA
363A00000X
Physician Assistant
17697
CA
363AM0700X
Medical Physician Assistant
17697
CA
363L00000X
Nurse Practitioner
Primary
15250
CA
363LC0200X
Critical Care Medicine Nurse Practitioner
15250
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA17697
—
CA
Enumeration date
11/11/2006
Last updated
01/28/2021
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