Provider Demographics
NPI:1750483491
Name:FALONK, LAURA (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:FALONK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 W ROOSEVELT HWY
Mailing Address - Street 2:
Mailing Address - City:WAYMART
Mailing Address - State:PA
Mailing Address - Zip Code:18472-9124
Mailing Address - Country:US
Mailing Address - Phone:570-282-4245
Mailing Address - Fax:
Practice Address - Street 1:100 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2116
Practice Address - Country:US
Practice Address - Phone:570-282-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN205264L367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00732786OtherRR MEDICARE
PA011153F4NMedicare PIN
PAP00732786OtherRR MEDICARE