Individual
MARY ELLEN SHANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN,BC,FNP
Contact information
Practice address
504 N STURGEON ST, MONTGOMERY CITY, MO 63361-1829
(573) 564-2990
(573) 564-2963
Mailing address
PO BOX 19, MONTGOMERY CITY, MO 63361-0019
(573) 564-2990
(573) 564-2963
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2010027851
MO
Other
Enumeration date
08/26/2010
Last updated
10/20/2020
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