Healthcare Provider Details

I. General information

NPI: 1659318624
Provider Name (Legal Business Name): MARY E. FALLS APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 OVERLOOK TER C-3125
MADISON WI
53705-2254
US

IV. Provider business mailing address

S5560 BLUFF RD
BARABOO WI
53913-9661
US

V. Phone/Fax

Practice location:
  • Phone: 608-256-1901
  • Fax: 608-280-7284
Mailing address:
  • Phone: 608-356-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: