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Individual

JONATHAN FALLON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
RN

Contact information

Practice address
1200 INTREPID AVE, PHILADELPHIA, PA 19112-1229
(800) 748-3243
Mailing address
1200 INTREPID AVE, PHILADELPHIA, PA 19112-1229

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
95140629
CA

Other

Enumeration date
10/20/2022
Last updated
10/20/2022
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