Individual
SUSAN ELAINE FAULKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
418 WARD AVE, CARUTHERSVILLE, MO 63830-1451
(573) 333-0030
(573) 333-0023
Mailing address
418 WARD AVE, CARUTHERSVILLE, MO 63830-1451
(573) 333-0030
(573) 333-0023
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
4917020057897
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447303664
—
MO
05
—
1548387145
—
MO
Enumeration date
02/13/2017
Last updated
02/13/2017
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