| Doctor Name: | MS. STACIA FALLERT |
| NPI Number: | 1164626826 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 041346618 |
| Business Practice Address: | 900 W Temple Ave Suite 101 Effingham, IL - 624012186 |
| Business Phone Number: | 2173472500 |
| Business Fax Number: | 2173429775 |
| Mailing Address: | 900 W Temple Ave, Suite 101 EFFINGHAM |
| State: | IL |
| Postal Code: | 624012186 |
| Phone Number: | 2173472500 |
| Fax Number: | 2173429775 |
| NPI Enumeration Date: | 06/14/2007 |
| NPI Last Update Date: | 03/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WM0705X |
| License Number: | 041346618 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Medical-Surgical |
| Taxonomy Definition: | |