MEDICARE: MRS. DANA SHIELDS CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	AP130343	TX

General Provider Information

NPI Number	:	1083073803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DANA SHIELDS CNM

Provider Business Mailing Address
First Line	:	1107 E MARSHALL AVE
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-5602
Country	:	US
Telephone Number	:	903-212-4763
Fax Number	:	903-758-7081

Provider Business Practice Location Address
First Line	:	2015 MULBERRY AVE STE 250
Second Line	:
City	:	MOUNT PLEASANT
State	:	TX
Zip	:	75455-2312
Country	:	US
Telephone Number	:	903-572-4664
Fax Number	:	903-572-4647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2016
Last Update Date	:	08/26/2025

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