Basic Information
| Provider Information | |||||||||
| NPI: | 1740431303 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FARRAUTO | ||||||||
| FirstName: | DEANNA | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | P.A.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22 THREADLEAF TER | ||||||||
| Address2: | |||||||||
| City: | BURLINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 080164348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6095316519 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 HADDON AVE | ||||||||
| Address2: | |||||||||
| City: | CAMDEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 081033101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8567573500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2008 | ||||||||
| LastUpdateDate: | 05/03/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP001839 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 25MP001839 | 01 | NJ | MEDICAL LICENSE | OTHER |