Shane D Faltys, CRNA
Nurse Anesthetist, Certified Registered in Poplar Bluff, MO. Individual provider (NPI-1).
NPI number1164640926
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1164640926
- Entity type
- Individual (NPI-1)
- Name
- Shane D Faltys
- Credential
- CRNA
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Apr 24, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | 2004031200 | MO | Yes |
| 367500000X | Nurse Anesthetist, Certified Registered | D-102109 | IA |
Practice location
2620 N Westwood BlvdPoplar Bluff, MO 63901-3396
Phone 573-718-2710
Mailing address
12747 Foxwood PtPoplar Bluff, MO 63901-7746
Phone 573-778-3870
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All 21 Certified Registered Nurse Anesthetist providers in Poplar Bluff · All 1,814 providers in Poplar Bluff
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