Provider Demographics
NPI:1639243561
Name:FALLON, DEBORAH BALL (RNP)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:BALL
Last Name:FALLON
Suffix:
Gender:F
Credentials:RNP
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 2424
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95611-2424
Mailing Address - Country:US
Mailing Address - Phone:916-425-9351
Mailing Address - Fax:
Practice Address - Street 1:3501 PALMER DR
Practice Address - Street 2:SUITE 204
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8276
Practice Address - Country:US
Practice Address - Phone:530-672-1311
Practice Address - Fax:530-672-1335
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF9761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily