1609085166 NPI number — MRS. AUBREY ELIZABETH SHIELDS OTRL

Table of content: MRS. AUBREY ELIZABETH SHIELDS OTRL (NPI 1609085166)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609085166 NPI number — MRS. AUBREY ELIZABETH SHIELDS OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
AUBREY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOWNER
Provider Other First Name:
AUBREY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTRL
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609085166
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 RED FOX CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKS HILL
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29821-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-279-3214
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1110 MARSHALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29646-4216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-227-7272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  2848 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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