1497037675 NPI number — BRITTANY ELLA FALLON NP-C

Table of content: BRITTANY ELLA FALLON NP-C (NPI 1497037675)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497037675 NPI number — BRITTANY ELLA FALLON NP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FALLON
Provider First Name:
BRITTANY
Provider Middle Name:
ELLA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP-C
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:
1497037675
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE DALLES
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97058-8003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-296-7668
Provider Business Mailing Address Fax Number:
541-296-6431

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1825 E 19TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE DALLES
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97058-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-506-6940
Provider Business Practice Location Address Fax Number:
541-296-2636
Provider Enumeration Date:
09/14/2011

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:  201250012NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500643643 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com