Provider Demographics
NPI:1366963399
Name:FARRIS, JAMIE (REGISTERED NURSE)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 GOLF COURSE ROAD NORTHWEST
Mailing Address - Street 2:SUITE D3 #121
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120
Mailing Address - Country:US
Mailing Address - Phone:505-933-2273
Mailing Address - Fax:505-839-0695
Practice Address - Street 1:8201 GOLF COURSE ROAD NORTHWEST
Practice Address - Street 2:SUITE D3 #121
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-933-2273
Practice Address - Fax:505-839-0695
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79721163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse