Provider Demographics
NPI:1831741164
Name:SHANKS, MOLLY KUHN (RN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KUHN
Last Name:SHANKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17606 RUSTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4233
Mailing Address - Country:US
Mailing Address - Phone:832-754-5637
Mailing Address - Fax:
Practice Address - Street 1:602 W SEMANDS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-1867
Practice Address - Country:US
Practice Address - Phone:936-756-5598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX603934163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse