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Individual

MILDRED SHIELDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
9712 E 84TH ST, RAYTOWN, MO 64138-3395
(816) 739-9852
Mailing address
9712 E 84TH ST, RAYTOWN, MO 64138-3395
(816) 739-9852

Taxonomy

Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary

Other

Enumeration date
08/18/2008
Last updated
08/18/2008
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