Individual
KELLY RAY SHANTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Mailing address
800 MEDICAL CENTER DR, FAIRMONT, MN 56031-4575
(507) 238-8555
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
868
MN
367500000X
Certified Registered Nurse Anesthetist
R 162289-8
MN
Other
Enumeration date
09/29/2005
Last updated
09/17/2020
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