Provider Demographics
NPI:1083073803
Name:SHIELDS, DANA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5602
Mailing Address - Country:US
Mailing Address - Phone:903-212-4763
Mailing Address - Fax:903-758-7081
Practice Address - Street 1:2015 MULBERRY AVE STE 250
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-2312
Practice Address - Country:US
Practice Address - Phone:903-572-4664
Practice Address - Fax:903-572-4647
Is Sole Proprietor?:No
Enumeration Date:2016-02-22
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130343367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife