Basic Information
| Provider Information | |||||||||
| NPI: | 1780759795 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FALCONE | ||||||||
| FirstName: | MARYANNE | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | FALCONE | ||||||||
| OtherFirstName: | MARYANNE | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 21600 POPLAR WAY | ||||||||
| Address2: | |||||||||
| City: | BRIER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980368132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4257758555 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11821 NE 128TH ST STE B | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980347210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258142800 | ||||||||
| FaxNumber: | 4258230882 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/22/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | MA00016680 | WA | Y | Other Service Providers | Specialist |
No ID Information.