1386784296 NPI number — CRYSTAL SHIELDS REGISTERED NURSE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386784296 NPI number — CRYSTAL SHIELDS REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
CRYSTAL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
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:
1386784296
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:
ROSEBUD IHS HOSPITAL
Provider Second Line Business Mailing Address:
SOLDIER CREEK ROAD
Provider Business Mailing Address City Name:
ROSEBUD
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-747-2231
Provider Business Mailing Address Fax Number:
605-747-2216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ROSEBUD IHS HOSPITAL
Provider Second Line Business Practice Location Address:
SOLDIER CREEK ROAD
Provider Business Practice Location Address City Name:
ROSEBUD
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-747-2231
Provider Business Practice Location Address Fax Number:
605-747-2216
Provider Enumeration Date:
02/08/2007

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: 163W00000X , with the licence number:  62089 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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