1891713426 NPI number — MS. SUSAN MARGARET SHIELDS RPH

Table of content: MS. SUSAN MARGARET SHIELDS RPH (NPI 1891713426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891713426 NPI number — MS. SUSAN MARGARET SHIELDS RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
SUSAN
Provider Middle Name:
MARGARET
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1891713426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
732 18TH ST APT 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DES MOINES
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50314-1027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-571-5957
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 ELM AVENUE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MITCHELLVILLE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-725-5065
Provider Business Practice Location Address Fax Number:
515-725-5070
Provider Enumeration Date:
07/18/2006

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: 183500000X , with the licence number:  16321 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1891713426 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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