NPI 1164640926

Shane D Faltys, CRNA

Practitioner Certified Registered Nurse Anesthetist Poplar Bluff, MO

Practice location

Address: 2620 N Westwood Blvd, Poplar Bluff, MO 63901-3396
Phone: (573) 718-2710
Mailing address: 12747 Foxwood PT, Poplar Bluff, MO 63901-7746

Registered specialties (2)

Certified Registered Nurse Anesthetist Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence 2004031200 (MO)

Other Nurse Anesthetist, Certified Registered providers in Missouri →

Certified Registered Nurse Anesthetist

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 367500000X Licence D-102109 (IA)

Registry record

NPI: 1164640926
Entity type: Individual
Sex (as registered): Male
NPI issued: 24 Apr 2007
Record last updated: 8 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.