Healthcare Provider Details

I. General information

NPI: 1922007731
Provider Name (Legal Business Name): KATHRYN M FALLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 CEDARCREST DR
DUNCANSVILLE PA
16635-7302
US

IV. Provider business mailing address

737 CEDARCREST DR
DUNCANSVILLE PA
16635-7302
US

V. Phone/Fax

Practice location:
  • Phone: 814-504-4034
  • Fax:
Mailing address:
  • Phone: 814-504-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberVP005192B
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: