MEDICARE: JENNY R. SHIELDS

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	343900000X	Non-emergency Medical Transport (VAN)	KOO600035	KS
2	343900000X	Non-emergency Medical Transport (VAN)	K00-60-0035	KS

General Provider Information

NPI Number	:	1700920600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNY R. SHIELDS

Provider Business Mailing Address
First Line	:	2246 ORVILLE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4751
Country	:	US
Telephone Number	:	913-279-1643
Fax Number	:

Provider Business Practice Location Address
First Line	:	2246 ORVILLE AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4751
Country	:	US
Telephone Number	:	913-279-1643
Fax Number	:

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

Provider Enumeration Date	:	02/16/2007
Last Update Date	:	07/08/2007

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