Provider Demographics
NPI:1568481828
Name:FALKNER, CAMILLE A (MD)
Entity Type:Individual
Prefix:
First Name:CAMILLE
Middle Name:A
Last Name:FALKNER
Suffix:
Gender:F
Credentials:MD
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 29502 #14970
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89126-9502
Mailing Address - Country:US
Mailing Address - Phone:702-476-3400
Mailing Address - Fax:702-476-3500
Practice Address - Street 1:38 S. WATER ST #200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015
Practice Address - Country:US
Practice Address - Phone:702-476-3400
Practice Address - Fax:702-476-3500
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11935207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100510111Medicaid
NVDR441AMedicare PIN
NVH69884Medicare PIN