Individual
MS. SHIRLEY A JAUTZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
221 PHYSICIANS PARK, POPLAR BLUFF, MO 63901-3956
(573) 727-9080
Mailing address
5983 US HIGHWAY 63, POMONA, MO 65789-9538
(573) 686-5550
(573) 686-2139
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
129615
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
917851503
—
MO
Enumeration date
08/05/2007
Last updated
04/09/2014
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