Provider Demographics
NPI:1578215851
Name:FALCON-GUZMAN, CONNIE (RN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:FALCON-GUZMAN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 W 125TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3416
Mailing Address - Country:US
Mailing Address - Phone:347-707-8531
Mailing Address - Fax:
Practice Address - Street 1:511 W 125TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-3416
Practice Address - Country:US
Practice Address - Phone:347-707-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY830075163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse