Individual
IAN FARAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-8266
(502) 852-3726
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 852-8266
(502) 852-3726
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1098104
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3003784
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74012048
—
KY
Enumeration date
03/03/2006
Last updated
09/17/2012
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