Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | RN2285119 | MA |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1033512595 | CA |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 95004253 | CA |
NPI | 1033512595 |
---|---|
Provider Name | Mrs. Denise Lee Falardeau |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2014 |
Last Update Date | 10/12/2020 |