Healthcare Provider Details

I. General information

NPI: 1528147840
Provider Name (Legal Business Name): KAREN SUZANNE SHIELDS R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 09/29/2021
Certification Date: 09/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 E 38TH ST
MARION IN
46953-4568
US

IV. Provider business mailing address

593 N 1000 E
MARION IN
46952-6644
US

V. Phone/Fax

Practice location:
  • Phone: 765-674-3321
  • Fax: 765-741-2994
Mailing address:
  • Phone: 765-934-2149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: