Basic Information
| Provider Information | |||||||||
| NPI: | 1104805159 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARWIG | ||||||||
| FirstName: | KATRINA | ||||||||
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| Credential: | M. A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2040 W CHARLESTON BLVD | ||||||||
| Address2: | 202-A | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712355 | ||||||||
| FaxNumber: | 7023825388 | ||||||||
| Practice Location | |||||||||
| Address1: | 2040 W CHARLESTON BLVD | ||||||||
| Address2: | 401 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891022227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7026712200 | ||||||||
| FaxNumber: | 7023857719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170300000X | NV | Y | Other Service Providers | Genetic Counselor, MS |
No ID Information.