Provider Demographics
NPI:1578621132
Name:MOLLMAN, SHARON KAY (RNFA)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:KAY
Last Name:MOLLMAN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:ELZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 19639
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9639
Mailing Address - Country:US
Mailing Address - Phone:217-545-7578
Mailing Address - Fax:217-545-1884
Practice Address - Street 1:421 N 9TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-5317
Practice Address - Country:US
Practice Address - Phone:217-545-5878
Practice Address - Fax:217-545-8013
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041-368444163WR0006X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant
No163W00000XNursing Service ProvidersRegistered Nurse