Healthcare Provider Details

I. General information

NPI: 1609497049
Provider Name (Legal Business Name): THERESA LYNN FALK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 NW WASHINGTON BLVD STE A
HAMILTON OH
45013-6367
US

IV. Provider business mailing address

300 HIGH ST FL 3
HAMILTON OH
45011-6078
US

V. Phone/Fax

Practice location:
  • Phone: 513-454-1111
  • Fax:
Mailing address:
  • Phone: 513-869-4917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.026674
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: