Healthcare Provider Details

I. General information

NPI: 1598054256
Provider Name (Legal Business Name): ALICIA SHIELDS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 E GIDEON WAY
GILBERT AZ
85296-2872
US

IV. Provider business mailing address

3810 E GIDEON WAY
GILBERT AZ
85296-2872
US

V. Phone/Fax

Practice location:
  • Phone: 480-251-4578
  • Fax:
Mailing address:
  • Phone: 480-251-4578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number333215
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: