Individual
STEFAN BRICE FARRELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNS, MSN
Contact information
Practice address
2251 N 32ND ST LOT 16, MESA, AZ 85213-2426
(480) 844-9817
(480) 461-9195
Mailing address
PO BOX 30361, MESA, AZ 85275-0361
(480) 844-9817
(480) 461-9195
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
RN 085383
AZ
364SP2800X
Perioperative Clinical Nurse Specialist
Primary
RN 085383
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
189762400
US LABOR
—
01
—
1Z4109
HEALTHNET
AZ
05
—
479073
—
AZ
01
—
7562119
CIGNA
—
01
—
890001034
RAILROAD
—
01
—
AZ 0167830
BC/BS
AZ
Enumeration date
10/17/2006
Last updated
01/23/2019
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