1326233495 NPI number — MS. ELIZABETH SHIELDS M.A.

Table of content: MS. ELIZABETH SHIELDS M.A. (NPI 1326233495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326233495 NPI number — MS. ELIZABETH SHIELDS M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326233495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9520 8TH AVE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98115-2117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-550-7320
Provider Business Mailing Address Fax Number:
425-889-9401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 KIRKLAND WAY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98033-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-550-7320
Provider Business Practice Location Address Fax Number:
425-889-9401
Provider Enumeration Date:
09/11/2007

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: 101YM0800X , with the licence number:  LH00008647 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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