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Individual

MI-KYONG KIM SHIELDS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
13634 N 93RD AVE STE 100, PEORIA, AZ 85381-4915
(623) 777-0081
Mailing address
16273 W. MEADE LANE, GOODYEAR, AZ 85338
(623) 910-1761

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP11206
AZ
363LA2100X
Acute Care Nurse Practitioner
AP11206
AZ
363LA2200X
Adult Health Nurse Practitioner
AP11206
AZ
363LC0200X
Critical Care Medicine Nurse Practitioner
AP11206
AZ
363LG0600X
Gerontology Nurse Practitioner
AP11206
AZ
363LP2300X
Primary Care Nurse Practitioner
AP11206
AZ

Other

Enumeration date
01/04/2019
Last updated
01/04/2019
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