Individual
MS. KELLY SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
3343 4TH AVE, SAN DIEGO, CA 92103-5703
(619) 299-0840
(619) 299-0892
Mailing address
3343 4TH AVE, SAN DIEGO, CA 92103-5703
(619) 299-0840
(619) 299-0892
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
CNM12240
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
619131
RN LICENSE
CA
Enumeration date
06/21/2007
Last updated
07/08/2007
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