Provider Demographics
NPI:1497479992
Name:FARRELLY, JOANNE CHRISTINE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:CHRISTINE
Last Name:FARRELLY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:OLSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1808 W BELTLINE HWY
Mailing Address - Street 2:SSM HEALTH FDL REGIONAL CLINIC-ATTN NANCY PIERCE
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-2334
Mailing Address - Country:US
Mailing Address - Phone:920-926-8343
Mailing Address - Fax:
Practice Address - Street 1:145 N MAIN ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3423
Practice Address - Country:US
Practice Address - Phone:920-926-8492
Practice Address - Fax:920-926-8903
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13637-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty