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General NPI Number Information
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NPI Number | 1104617992
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Entity Type | Individual
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Provider Name | ALYSSA ISABEL FALLON
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 248 E 13800 S STE 3
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City | DRAPER
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State | UT
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Zip | 84020-5011
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Country | US
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Telephone | 801-987-8384
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Fax |
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Provider Business Mailing Address
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Address Line | 826 E 1080 N
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City | LEHI
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State | UT
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Zip | 84043-1356
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Country | US
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Telephone | 760-585-8659
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 133051654405
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License Number State | UT
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