=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104322825
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA CATHERINE FALLS DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2018
-----------------------------------------------------
Last Update Date | 07/21/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 GLESSNER AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44903-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-756-8899
-----------------------------------------------------
Fax | 419-756-6004
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 GLESSNER AVE
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44903-2269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-756-8899
-----------------------------------------------------
Fax | 419-756-6004
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 390200000X
-----------------------------------------------------
Taxonomy Name | Student in an Organized Health Care Education/Training Program
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 34.016408
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------