Provider Demographics
NPI:1932297504
Name:FALLER, LINDA MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:MARIE
Last Name:FALLER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2029 BENNETT AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-2115
Mailing Address - Country:US
Mailing Address - Phone:847-328-6894
Mailing Address - Fax:773-989-8345
Practice Address - Street 1:5900 N. GLENWOOD AVE
Practice Address - Street 2:SCHOOL HEALTH CENTER AT NICHOLAS SENN HIGH SCHOOL
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-3312
Practice Address - Country:US
Practice Address - Phone:773-989-8322
Practice Address - Fax:773-989-8345
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL085-000187363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical