Provider Demographics
NPI:1134560816
Name:MOLDEN, SHANNON MARY (R N)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARY
Last Name:MOLDEN
Suffix:
Gender:F
Credentials:R N
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:547 E RIDGEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HERMISTON
Mailing Address - State:OR
Mailing Address - Zip Code:97838-1935
Mailing Address - Country:US
Mailing Address - Phone:541-720-9277
Mailing Address - Fax:
Practice Address - Street 1:547 E RIDGEWAY AVE
Practice Address - Street 2:
Practice Address - City:HERMISTON
Practice Address - State:OR
Practice Address - Zip Code:97838-1935
Practice Address - Country:US
Practice Address - Phone:541-720-9277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093000129RN163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management