Provider Demographics
NPI:1073920633
Name:FALK, DEREK (NP)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:
Last Name:FALK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13924 WADAGA RD
Mailing Address - Street 2:
Mailing Address - City:BARAGA
Mailing Address - State:MI
Mailing Address - Zip Code:49908-9204
Mailing Address - Country:US
Mailing Address - Phone:906-353-7070
Mailing Address - Fax:
Practice Address - Street 1:13924 WADAGA RD
Practice Address - Street 2:
Practice Address - City:BARAGA
Practice Address - State:MI
Practice Address - Zip Code:49908-9204
Practice Address - Country:US
Practice Address - Phone:906-353-7070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704260522363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health