Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 53-79752-112 | KS |
Y | 363L00000X | Nurse Practitioner | 53-79752-112 | KS |
NPI | 1023615648 |
---|---|
Provider Name | Lori E Falcone |
First Address | Derby, KS 67037-8726 |
Second Address | Derby, KS 67037-3667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2020 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
53-79752-112 | APRN (01) | KS |