Healthcare Provider Details

I. General information

NPI: 1972925956
Provider Name (Legal Business Name): STEPHANIE FALLERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE MONTEZ

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 ANTHONY DR.
ANTHONY NM
88021
US

IV. Provider business mailing address

385 CALLE DE ALEGRA STE A
LAS CRUCES NM
88005
US

V. Phone/Fax

Practice location:
  • Phone: 575-201-5135
  • Fax: 575-201-5131
Mailing address:
  • Phone: 575-526-1105
  • Fax: 575-524-4266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: