Provider Demographics
NPI:1528832656
Name:FARRELL, AMANDA LEA (MSN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:LEA
Last Name:FARRELL
Suffix:
Gender:F
Credentials:MSN, CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 DREXEL AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-1311
Mailing Address - Country:US
Mailing Address - Phone:610-675-4007
Mailing Address - Fax:
Practice Address - Street 1:1001 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-3805
Practice Address - Country:US
Practice Address - Phone:610-576-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028619363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care