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Individual

KELLYJEAN FARRELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
3 LOTUS RD, BAYPORT, NY 11705-1736
(631) 218-0604
(631) 244-5814
Mailing address
3 LOTUS RD, BAYPORT, NY 11705-1736
(631) 218-0604
(631) 244-5814

Taxonomy

Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
22527877
NY

Other

Enumeration date
11/07/2016
Last updated
11/07/2016
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