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General NPI Number Information
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NPI Number | 1003395716
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Entity Type | Individual
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Provider Name | WALTER RICHARD SHEILDS JR. RN
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Gender | Male
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Dates
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Enumeration Date | 08/13/2018
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 770 WOODLANE RD
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City | MT HOLLY
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State | NJ
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Zip | 08060
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Country | US
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Telephone | 856-495-4601
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Fax |
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Provider Business Mailing Address
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Address Line | 770 WOODLANE RD
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City | MT HOLLY
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State | NJ
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Zip | 08060
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Country | US
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Telephone | 856-495-4601
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 26NR10941600
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License Number State | NJ
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