Most Relevant Information
Provider Data
| NPI Number: | 1003525510 |
| Provider Name: | SHANE CHARLES, FALBE QUELLA |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: | 72121 |
Most Important Dates
| Enumeration Date: | 11/23/2022 |
| Last Updated: | 11/23/2022 |
Provider Practice Location
25 KESSEL CT STE 105
MADISON
WI
537116227
Practice Location Phone/Fax
| Phone: | 6082802700 |
| Fax: |
Provider Mailing Location
25 KESSEL CT STE 105
MADISON
WI
537116227
Provider Mailing Phone/Fax
| Phone: | 6082802700 |
| Fax: |