Provider Demographics
NPI:1326663915
Name:FALCONER, COURTNEY MARIE (NP)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:FALCONER
Suffix:
Gender:F
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:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:
Practice Address - Street 1:1401 MASSACHUSETTS AVE
Practice Address - Street 2:TROY INTERNAL MEDICINE
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1621
Practice Address - Country:US
Practice Address - Phone:518-268-5242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309879363LA2200X
NY696345163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse