Most Relevant Information
Provider Data
| NPI Number: | 1003570680 |
| Provider Name: | MOLLY FORKNER RD |
| Entity Type: | Individual |
| Taxonomy Code: | 133V00000X |
| Specialty: | Dietitian, Registered |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/28/2021 |
| Last Updated: | 10/28/2021 |
Provider Practice Location
5401 ROCK CHALK DR APT 13308
LAWRENCE
KS
660495054
Practice Location Phone/Fax
| Phone: | 5412072256 |
| Fax: |
Provider Mailing Location
5401 ROCK CHALK DR APT 13308
LAWRENCE
KS
660495054
Provider Mailing Phone/Fax
| Phone: | 5412072256 |
| Fax: |