Healthcare Provider Details

I. General information

NPI: 1346332335
Provider Name (Legal Business Name): LOIS FALK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46900 OCEAN DR
GUALALA CA
95445-8353
US

IV. Provider business mailing address

PO BOX 1100
GUALALA CA
95445-1100
US

V. Phone/Fax

Practice location:
  • Phone: 707-884-4005
  • Fax: 707-884-9728
Mailing address:
  • Phone: 707-884-4005
  • Fax: 707-884-9728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP2525
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: