Provider Demographics
NPI:1922757079
Name:MOLKENBUR, HANNAH SHIRLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:SHIRLEY
Last Name:MOLKENBUR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E PRIMROSE ST STE D
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7910
Mailing Address - Country:US
Mailing Address - Phone:417-882-1818
Mailing Address - Fax:417-882-1821
Practice Address - Street 1:1536 E PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7928
Practice Address - Country:US
Practice Address - Phone:417-882-1818
Practice Address - Fax:417-882-1821
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2022010163363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant