Provider Demographics
NPI:1528147840
Name:SHIELDS, KAREN SUZANNE (RD)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUZANNE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 N 1000 E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-6644
Mailing Address - Country:US
Mailing Address - Phone:765-934-2149
Mailing Address - Fax:
Practice Address - Street 1:1700 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46953-4568
Practice Address - Country:US
Practice Address - Phone:765-674-3321
Practice Address - Fax:765-741-2994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN296500WMedicare ID - Type UnspecifiedUPLAND HEALTH & DIAG
IN940810EMedicare Oscar/Certification