Provider Demographics
NPI:1881476893
Name:FALDON, AMBERLYN MONIQUE
Entity type:Individual
Prefix:
First Name:AMBERLYN
Middle Name:MONIQUE
Last Name:FALDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-5321
Mailing Address - Country:US
Mailing Address - Phone:479-471-4600
Mailing Address - Fax:479-430-7596
Practice Address - Street 1:2010 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-5321
Practice Address - Country:US
Practice Address - Phone:479-471-4600
Practice Address - Fax:479-430-7596
Is Sole Proprietor?:No
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220147163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse