Provider Demographics
NPI:1598118358
Name:SHIELDS, SHANNON MARY (APRN)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARY
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SHANNON
Other - Middle Name:MARY
Other - Last Name:VAN MARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SC HOUSE CALLS INC.
Mailing Address - Street 2:111 DOCTORS CIR.
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203
Mailing Address - Country:US
Mailing Address - Phone:800-491-0909
Mailing Address - Fax:865-560-7110
Practice Address - Street 1:SC HOUSE CALLS INC.
Practice Address - Street 2:111 DOCTORS CIR.
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203
Practice Address - Country:US
Practice Address - Phone:800-491-0909
Practice Address - Fax:865-560-7110
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001762363LF0000X
SC20357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily