MEDICARE: LOIS W SHIELDS NP

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	363L00000X	Nurse Practitioner	0017137868	VA

General Provider Information

NPI Number	:	1306809850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS W SHIELDS NP

Provider Business Mailing Address
First Line	:	PO BOX 2696
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23609
Country	:	US
Telephone Number	:	757-874-0320
Fax Number	:	757-989-0276

Provider Business Practice Location Address
First Line	:	914 DENBIGH BLVD
Second Line	:
City	:	GRAFTON
State	:	VA
Zip	:	23692
Country	:	US
Telephone Number	:	757-874-0320
Fax Number	:	757-989-0276

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

Provider Enumeration Date	:	04/07/2006
Last Update Date	:	07/08/2007

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