Provider Demographics
NPI:1780759795
Name:FALCONE, MARYANNE G
Entity type:Individual
Prefix:
First Name:MARYANNE
Middle Name:G
Last Name:FALCONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARYANNE
Other - Middle Name:
Other - Last Name:FALCONE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:21600 POPLAR WAY
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8132
Mailing Address - Country:US
Mailing Address - Phone:425-775-8555
Mailing Address - Fax:
Practice Address - Street 1:11821 NE 128TH ST STE B
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7210
Practice Address - Country:US
Practice Address - Phone:425-814-2800
Practice Address - Fax:425-823-0882
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00016680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist