Provider Demographics
NPI:1417247966
Name:SHIELDS, ALISHA M (LPN)
Entity Type:Individual
Prefix:MRS
First Name:ALISHA
Middle Name:M
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MRS
Other - First Name:ALISHA
Other - Middle Name:M
Other - Last Name:SHIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:113 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-3417
Mailing Address - Country:US
Mailing Address - Phone:804-328-1566
Mailing Address - Fax:
Practice Address - Street 1:113 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-3417
Practice Address - Country:US
Practice Address - Phone:804-328-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0002075965164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse