MEDICARE: SHARON MARIE SHIELDS ARNP

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	363LP0200X	Pediatric Nurse Practitioner	3094P	KY

General Provider Information

NPI Number	:	1770637589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MARIE SHIELDS ARNP

Provider Business Mailing Address
First Line	:	110 3RD ST STE 180
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5808
Country	:	US
Telephone Number	:	270-827-3573
Fax Number	:	207-827-1250

Provider Business Practice Location Address
First Line	:	110 3RD ST STE 180
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-5808
Country	:	US
Telephone Number	:	270-827-3573
Fax Number	:	207-827-1250

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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