1609120161 NPI number — REBECCA LYNN SHIELDS A.P.R.N.

NPI Number: 1609120161
Health Care Provider/Practitioner: REBECCA LYNN SHIELDS A.P.R.N.

NPI Number : 1609120161 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1609120161",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SHIELDS",
    "FirstName": "REBECCA",
    "MiddleName": "LYNN",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "A.P.R.N.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "817 CHADWICK DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WATERTOWN",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53094-5923",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "262-719-8974",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1200 S 9TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WATERTOWN",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53094-6604",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "262-719-8974",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/06/2012",
    "LastUpdateDate": "06/18/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "166428-30",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WP0000X",
          "TaxonomyName": "Pain Management Registered Nurse",
          "LicenseNumber": "166428-30",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}