Healthcare Provider Details

I. General information

NPI: 1104246727
Provider Name (Legal Business Name): ELIZABETH ANN FALICON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 NEWPORT RD SUITE 107
NEW LONDON NH
03257-5468
US

IV. Provider business mailing address

276 NEWPORT RD SUITE 107
NEW LONDON NH
03257-5468
US

V. Phone/Fax

Practice location:
  • Phone: 603-526-4144
  • Fax:
Mailing address:
  • Phone: 603-526-4144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number06303223
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: