Individual
NICOLE MARIE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
133 S MAIN ST, MOUNT CLEMENS, MI 48043-2308
(586) 468-1600
(586) 465-0329
Mailing address
2689 SOLUTION CENTER, CHICAGO, IL 60677-2464
(586) 329-1880
(586) 231-0055
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
5601007332
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5315080570
CONTROLLED SUBSTANCE LICENSE
MI
01
—
5601007332
PHYSICIAN ASSISTANT LICENSE
MI
Enumeration date
08/05/2015
Last updated
03/07/2023
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