Provider Demographics
NPI:1346332335
Name:FALK, LOIS (NP)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:FALK
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 1100
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1100
Mailing Address - Country:US
Mailing Address - Phone:707-884-4005
Mailing Address - Fax:707-884-9728
Practice Address - Street 1:46900 OCEAN DR
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8353
Practice Address - Country:US
Practice Address - Phone:707-884-4005
Practice Address - Fax:707-884-9728
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP2525363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC03906FMedicaid
CAFHC03906FMedicaid