Provider Demographics
NPI:1902221948
Name:FALLON, CHRISTINE (RN)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:FALLON
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 1:30 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5547
Mailing Address - Country:US
Mailing Address - Phone:508-778-0300
Mailing Address - Fax:
Practice Address - Street 1:30 ELM AVE
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5547
Practice Address - Country:US
Practice Address - Phone:508-778-0300
Practice Address - Fax:508-778-8747
Is Sole Proprietor?:No
Enumeration Date:2014-02-27
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN-2261701163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse