Individual
NICOLE SHIELDS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6990 N 43RD ST, MILWAUKEE, WI 53209-2217
(414) 514-0342
Mailing address
6990 N 43RD ST, MILWAUKEE, WI 53209-2217
(414) 514-0342
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
872806246
—
WI
Enumeration date
09/25/2021
Last updated
09/25/2021
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