Healthcare Provider Details

I. General information

NPI: 1508324187
Provider Name (Legal Business Name): GLORIA ANN SHIELDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 N JUDGE ST
BLOOMFIELD IN
47424-1231
US

IV. Provider business mailing address

1185 N 1000 W
LINTON IN
47441-5282
US

V. Phone/Fax

Practice location:
  • Phone: 812-847-4481
  • Fax: 844-658-7526
Mailing address:
  • Phone: 812-847-5212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28161000A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008932A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: