Provider Demographics
NPI:1942925094
Name:LALLY, FAITH ROSE (NP)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:ROSE
Last Name:LALLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:
Other - Last Name:DEVLIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:444 EAST MARSHALL STREET
Mailing Address - Street 2:STE 101
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380
Mailing Address - Country:US
Mailing Address - Phone:610-738-2500
Mailing Address - Fax:
Practice Address - Street 1:444 EAST MARSHALL STREET
Practice Address - Street 2:STE 101
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5415
Practice Address - Country:US
Practice Address - Phone:610-738-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP026087363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology