1659494250 NPI number — MRS. DAWN B TRANI-FALLON A.P.N.

Table of content: MRS. DAWN B TRANI-FALLON A.P.N. (NPI 1659494250)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659494250 NPI number — MRS. DAWN B TRANI-FALLON A.P.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRANI-FALLON
Provider First Name:
DAWN
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
A.P.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659494250
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1638
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12201-1638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-777-4111
Provider Business Mailing Address Fax Number:
207-783-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 CAMPUS AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-6045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-777-8810
Provider Business Practice Location Address Fax Number:
207-777-8155
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  CNP101075 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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