Provider Demographics
NPI:1023240645
Name:SHIELDS, LYNN MARIE (ACNP/FNP)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:MARIE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:ACNP/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7417
Mailing Address - Fax:719-542-0809
Practice Address - Street 1:4491 BENT BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO CITY
Practice Address - State:CO
Practice Address - Zip Code:81019-9990
Practice Address - Country:US
Practice Address - Phone:719-595-7525
Practice Address - Fax:719-595-7965
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5987363LA2100X, 363LP2300X
CO5988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06358306Medicaid