MEDICARE: MS. DEBRA LYNN FALVO MHSA, RN C.

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	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	213554-3102	UT

General Provider Information

NPI Number	:	1497745301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA LYNN FALVO MHSA, RN C.

Provider Business Mailing Address
First Line	:	2506 BARCELONA DR
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84093-1147
Country	:	US
Telephone Number	:	801-733-5704
Fax Number	:

Provider Business Practice Location Address
First Line	:	5965 S 900 E
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84121-1720
Country	:	US
Telephone Number	:	801-263-7100
Fax Number	:	801-263-7123

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	03/20/2008

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