Provider Demographics
NPI:1225360944
Name:FALCON, KISHA MARIE
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:MARIE
Last Name:FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 ROCKWOOD DR
Mailing Address - Street 2:APT. 44 A
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-5957
Mailing Address - Country:US
Mailing Address - Phone:845-467-0549
Mailing Address - Fax:
Practice Address - Street 1:64 ROCKWOOD DR
Practice Address - Street 2:APT. 44 A
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-5957
Practice Address - Country:US
Practice Address - Phone:845-467-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse