Individual
JESSE FAULKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 S JACKSON ST, LOUISVILLE, KY 40202-1675
(502) 852-5851
Mailing address
744 S WEBSTER AVE, GREEN BAY, WI 54301-3505
(920) 445-7226
(920) 445-7229
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
2016019747
MO
367500000X
Certified Registered Nurse Anesthetist
Primary
3013686
KY
Other
Enumeration date
06/16/2016
Last updated
08/12/2019
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