Provider Demographics
NPI:1235158395
Name:SHIELS, JANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JANN
Middle Name:
Last Name:SHIELS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 N SAN FRANCISCO ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3266
Mailing Address - Country:US
Mailing Address - Phone:928-779-0341
Mailing Address - Fax:928-774-4994
Practice Address - Street 1:1024 N SAN FRANCISCO ST
Practice Address - Street 2:SUITE 105
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3266
Practice Address - Country:US
Practice Address - Phone:928-779-0341
Practice Address - Fax:928-774-4994
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22985207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
86-0559827OtherTAX ID #
86-0559827OtherTAX ID #