Healthcare Provider Details

I. General information

NPI: 1447660733
Provider Name (Legal Business Name): MARY SHIELS RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2014
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ESSEX ST
SAN FRANCISCO CA
94105-3195
US

IV. Provider business mailing address

25 ESSEX ST
SAN FRANCISCO CA
94105-3195
US

V. Phone/Fax

Practice location:
  • Phone: 415-767-3404
  • Fax: 415-977-0168
Mailing address:
  • Phone: 415-767-3404
  • Fax: 415-977-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number803584
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: