Provider Demographics
NPI:1457310781
Name:SHIELDS, KAREN M (CNM)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:M
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 1:389 HARDING HWY
Mailing Address - Street 2:PO BOX 558
Mailing Address - City:ELMER
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-2050
Mailing Address - Country:US
Mailing Address - Phone:856-358-1100
Mailing Address - Fax:856-358-1313
Practice Address - Street 1:389 HARDING HWY
Practice Address - Street 2:SUITE 6
Practice Address - City:ELMER
Practice Address - State:NJ
Practice Address - Zip Code:08318-2050
Practice Address - Country:US
Practice Address - Phone:856-358-1100
Practice Address - Fax:856-358-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO09537400176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6340202Medicaid
NJ6340202Medicaid
NJ762536Medicare ID - Type Unspecified