Healthcare Provider Details

I. General information

NPI: 1154656049
Provider Name (Legal Business Name): MANUEL A FALCON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 09/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

IV. Provider business mailing address

601 NW WAVERLY CIR
PORT ST LUCIE FL
34983-3410
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax:
Mailing address:
  • Phone: 860-478-9296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberE59980
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRNA163034
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9339865
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: