Provider Demographics
NPI:1174626162
Name:SHIELDS, ANNE E (FNP, CS P-MH)
Entity type:Individual
Prefix:MS
First Name:ANNE
Middle Name:E
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:FNP, CS P-MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 E LOOP 281 STE B-232
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-5077
Mailing Address - Country:US
Mailing Address - Phone:903-475-2602
Mailing Address - Fax:
Practice Address - Street 1:4055 E BLUEBERRY ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-8261
Practice Address - Country:US
Practice Address - Phone:208-775-7418
Practice Address - Fax:208-647-5008
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX238667363LF0000X, 364SP0808X
ID66573364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily