Individual
NICOLE MARIE SHIELDS
Active
Individual
NICOLE MARIE SHIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
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
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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