Provider Demographics
NPI:1568288223
Name:FAVALORO, ECHO DASHAWN (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ECHO
Middle Name:DASHAWN
Last Name:FAVALORO
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6A ROAD 2930
Mailing Address - Street 2:
Mailing Address - City:AZTEC
Mailing Address - State:NM
Mailing Address - Zip Code:87410-9718
Mailing Address - Country:US
Mailing Address - Phone:505-258-0616
Mailing Address - Fax:
Practice Address - Street 1:6A ROAD 2930
Practice Address - Street 2:
Practice Address - City:AZTEC
Practice Address - State:NM
Practice Address - Zip Code:87410-9718
Practice Address - Country:US
Practice Address - Phone:505-258-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM61910363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily