NICOLE MARIE SHIELDS PA-C NPI 1073999629

NPI Information

NPI: 1073999629
Provider Name: NICOLE MARIE SHIELDS, PA-C
Classification: Physician Assistant - 363AM0700X
Entity Type: Individual

Specialization: Medical

PECOS Registration: Yes

Address:
133 S MAIN ST
MOUNT CLEMENS, MI
ZIP 48043
Phone: (586) 468-1600
Get Directions

Nicole Marie Shields, PA-C is a medical physician assistant in Mount Clemens, MI with 9 years of experience. Nicole Marie Shields, PA-C NPI is 1073999629. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

133 S MAIN ST
MOUNT CLEMENS, MI
ZIP 48043-308
Phone: (586) 468-1600
Fax: (586) 465-0329

The NPI 1073999629 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/5/2015 and was last updated on 3/7/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AM0700X	Physician Assistant	Medical	5601007332	MICHIGAN	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	5315080570	OTHER	MICHIGAN	CONTROLLED SUBSTANCE LICENSE
2	5601007332	OTHER	MICHIGAN	PHYSICIAN ASSISTANT LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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