Provider Demographics
NPI:1023524634
Name:FALLON, PATRICIA ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANNE
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 1:6407 55TH AVE
Mailing Address - Street 2:
Mailing Address - City:MASPETH
Mailing Address - State:NY
Mailing Address - Zip Code:11378-1623
Mailing Address - Country:US
Mailing Address - Phone:646-427-2801
Mailing Address - Fax:
Practice Address - Street 1:6407 55TH AVE
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1623
Practice Address - Country:US
Practice Address - Phone:646-427-2801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2017-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY421104163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse