| Doctor Name: | MARY ELLEN SHANKS |
| NPI Number: | 1710293972 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN,BC,FNP |
| License Number: | 2010027851 |
| Business Practice Address: | 504 N Sturgeon St Montgomery City, MO - 633611829 |
| Business Phone Number: | 5735642990 |
| Business Fax Number: | 5735642963 |
| Mailing Address: | Po Box 19, MONTGOMERY CITY |
| State: | MO |
| Postal Code: | 633610019 |
| Phone Number: | 5735642990 |
| Fax Number: | 5735642963 |
| NPI Enumeration Date: | 08/26/2010 |
| NPI Last Update Date: | 02/08/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2010027851 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |