Provider Demographics
NPI:1508491176
Name:FALLON, LISA M (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:FALLON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:MASSEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:1335 GERONIMO DR STE 8
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1836
Mailing Address - Country:US
Mailing Address - Phone:915-591-2704
Mailing Address - Fax:915-598-3946
Practice Address - Street 1:6974 GATEWAY BLVD E STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-1115
Practice Address - Country:US
Practice Address - Phone:915-591-2704
Practice Address - Fax:915-598-3946
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPI44027363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily