Provider Demographics
NPI:1104246727
Name:FALICON, ELIZABETH ANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:FALICON
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 NEWPORT RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5468
Mailing Address - Country:US
Mailing Address - Phone:603-526-4144
Mailing Address - Fax:
Practice Address - Street 1:276 NEWPORT RD
Practice Address - Street 2:SUITE 107
Practice Address - City:NEW LONDON
Practice Address - State:NH
Practice Address - Zip Code:03257-5468
Practice Address - Country:US
Practice Address - Phone:603-526-4144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH06303223363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily