Most Relevant Information
Provider Data
| NPI Number: | 1003262742 |
| Provider Name: | THERESA FALLER |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 301751-31 |
Most Important Dates
| Enumeration Date: | 05/12/2016 |
| Last Updated: | 05/12/2016 |
Provider Practice Location
4800 S 10TH ST
MILWAUKEE
WI
532212412
Practice Location Phone/Fax
| Phone: | 4147445370 |
| Fax: | 4147449052 |
Provider Mailing Location
5956 S KINGAN AVE APT 8
CUDAHY
WI
531103448
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |