Healthcare Provider Details

I. General information

NPI: 1497745301
Provider Name (Legal Business Name): DEBRA LYNN FALVO MHSA, RN C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 S 900 E
SALT LAKE CITY UT
84121-1720
US

IV. Provider business mailing address

2506 BARCELONA DR
SANDY UT
84093-1147
US

V. Phone/Fax

Practice location:
  • Phone: 801-263-7100
  • Fax: 801-263-7123
Mailing address:
  • Phone: 801-733-5704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number213554-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: