Individual
MR. SHELBY TANNER MOLLENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1500 SW 10TH AVE, TOPEKA, KS 66604-1301
(785) 354-6000
Mailing address
4 E PIANKISHAW ST, PAOLA, KS 66071-1717
(785) 754-8265
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
13-120438-042
KS
367500000X
Certified Registered Nurse Anesthetist
Primary
557708
KS
Other
Enumeration date
03/11/2019
Last updated
08/23/2023
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