Individual
SHANE D FALTYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2620 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-3396
(573) 718-2710
Mailing address
12747 FOXWOOD PT, POPLAR BLUFF, MO 63901-7746
(573) 778-3870
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2004031200
MO
367500000X
Certified Registered Nurse Anesthetist
D-102109
IA
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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