Healthcare Provider Details

I. General information

NPI: 1174807432
Provider Name (Legal Business Name): ELIZABETH CLAIRE FALK WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

IV. Provider business mailing address

333 E CAMPUS MALL
MADISON WI
53715-1365
US

V. Phone/Fax

Practice location:
  • Phone: 608-265-5600
  • Fax:
Mailing address:
  • Phone: 608-265-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number155521030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: