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NPI Code Detail

MEDICARE: KRISTIN MAE SHIELDS NP

MEDICARE: KRISTIN MAE 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
1363L00000XNurse Practitioner8568206-4405UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1297449OTHEROROMAP

General Provider Information

NPI Number : 1720154883
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTIN MAE SHIELDS NP
Provider Business Mailing Address
First Line : 654 S 900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3478
Country : US
Telephone Number : 801-532-1586
Fax Number :
Provider Business Practice Location Address
First Line : 654 S 900 E
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84102-3478
Country : US
Telephone Number : 801-532-1586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2006
Last Update Date : 11/04/2013

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