Individual
ANTOINETTE SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
459 PHILO RD, ELMIRA, NY 14903-1051
(607) 739-3581
Mailing address
459 PHILO RD, ELMIRA, NY 14903-1051
(607) 739-3581
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
310804-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310804-1
RN LICENSE NUMBER
NY
Enumeration date
03/04/2019
Last updated
03/04/2019
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