Provider Demographics
NPI:1700962719
Name:FALOTICO, MARY JANE B (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:B
Last Name:FALOTICO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:MARY JANE
Other - Middle Name:
Other - Last Name:BONDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:424 CONCORD AVE
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-1818
Mailing Address - Country:US
Mailing Address - Phone:610-363-2209
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACKHORSE HILL RD
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2040
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN164074L163W00000X
PAUP005267B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily