Individual
TIMOTHY D SHIELDS
Active
Individual
TIMOTHY D SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0064541
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200021240A
—
OK
01
—
OK401908
MEDICARE ID-TYPE UNSPECIFIED
OK
Enumeration date
05/25/2006
Last updated
10/01/2009
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