Provider Demographics
NPI:1922798578
Name:FALLON, RHIANNON (CRM)
Entity Type:Individual
Prefix:
First Name:RHIANNON
Middle Name:
Last Name:FALLON
Suffix:
Gender:F
Credentials:CRM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N RIVERSIDE AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97501-4601
Mailing Address - Country:US
Mailing Address - Phone:582-293-5554
Mailing Address - Fax:
Practice Address - Street 1:1025 E MAIN ST STE 108
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-7690
Practice Address - Country:US
Practice Address - Phone:541-200-1530
Practice Address - Fax:541-772-0284
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR23-CRM-1693175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist