=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366008120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMY MARIE FALCONE-WHARTON MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/16/2019
-----------------------------------------------------
Last Update Date | 05/16/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1701 N GREEN VALLEY PKWY BLDG 3 STE B
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-737-3200
-----------------------------------------------------
Fax | 702-369-4727
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1701 N GREEN VALLEY PKWY BLDG 3 STE B
-----------------------------------------------------
City | HENDERSON
-----------------------------------------------------
State | NV
-----------------------------------------------------
Zip | 89074-5885
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-737-3200
-----------------------------------------------------
Fax | 702-369-4727
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CREDENTIALING MANAGER
-----------------------------------------------------
Name | TERESA BRANSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 702-712-4869
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------