Provider Demographics
NPI:1245588961
Name:FLOWERS, FALLON M (APRN, WHNP-BC)
Entity Type:Individual
Prefix:
First Name:FALLON
Middle Name:M
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:APRN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9244 S DUNBAR AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-7358
Mailing Address - Country:US
Mailing Address - Phone:773-844-9064
Mailing Address - Fax:773-341-4036
Practice Address - Street 1:6250 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2530
Practice Address - Country:US
Practice Address - Phone:312-682-6110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.397175163WN1003X
IL209017136363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WN1003XNursing Service ProvidersRegistered NurseNutrition Support