Provider Demographics
NPI:1902243892
Name:ROBERTO, FARRAH JEAN (LPN)
Entity Type:Individual
Prefix:
First Name:FARRAH
Middle Name:JEAN
Last Name:ROBERTO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:FARRAH
Other - Middle Name:JEAN
Other - Last Name:DE LIMA ROBERTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:466 BENNETT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:LUZERNE
Mailing Address - State:PA
Mailing Address - Zip Code:18709-1553
Mailing Address - Country:US
Mailing Address - Phone:570-687-5143
Mailing Address - Fax:
Practice Address - Street 1:746 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1624
Practice Address - Country:US
Practice Address - Phone:570-687-5143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN279056164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse