Healthcare Provider Details

I. General information

NPI: 1740001718
Provider Name (Legal Business Name): FALLON BINA HOPE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FALLON MASHKOVICH

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
CHESTER PA
19013-3995
US

IV. Provider business mailing address

717 S COLUMBUS BLVD APT PH-3
PHILADELPHIA PA
19147-3506
US

V. Phone/Fax

Practice location:
  • Phone: 610-447-2000
  • Fax:
Mailing address:
  • Phone: 215-478-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP030976
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberSP030976
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: