Healthcare Provider Details

I. General information

NPI: 1497037675
Provider Name (Legal Business Name): BRITTANY ELLA FALLON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 E 19TH ST
THE DALLES OR
97058-3365
US

IV. Provider business mailing address

PO BOX 1520
THE DALLES OR
97058-8003
US

V. Phone/Fax

Practice location:
  • Phone: 541-506-6940
  • Fax: 541-296-2636
Mailing address:
  • Phone: 541-296-7668
  • Fax: 541-296-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number201250012NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: