Provider Demographics
NPI:1003395716
Name:SHEILDS, WALTER RICHARD JR (RN)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:RICHARD
Last Name:SHEILDS
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 WOODLANE RD
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060
Mailing Address - Country:US
Mailing Address - Phone:856-495-4601
Mailing Address - Fax:
Practice Address - Street 1:770 WOODLANE RD
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:856-495-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR10941600163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice