MEDICARE: MS. JULIANNE FALLENTINE CFNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	219839-4405	UT

General Provider Information

NPI Number	:	1356366181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIANNE FALLENTINE CFNP

Provider Business Mailing Address
First Line	:	855 CALIFORNIA AVE
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84104-1632
Country	:	US
Telephone Number	:	801-977-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 CALIFORNIA AVE
Second Line	:
City	:	SLC
State	:	UT
Zip	:	84104-1632
Country	:	US
Telephone Number	:	801-977-0502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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