Provider Demographics
NPI:1356774046
Name:FALLON, CAROLINE J (APRN)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:J
Last Name:FALLON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:J
Other - Last Name:VIETEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DHMC - CRITICAL CARE
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-4642
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DHMC - CRITICAL CARE
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-4642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH061180-23363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care