Individual
IAN A SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2014 S 6TH ST, BRAINERD, MN 56401-4529
(218) 829-7812
Mailing address
1702 UNIVERSITY DR S, FARGO, ND 58103-4940
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
15078
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
02/27/2018
Last updated
10/03/2024
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