Provider Demographics
NPI:1548387038
Name:SHIELDS, RENEE LYNN (HHA)
Entity Type:Individual
Prefix:MS
First Name:RENEE
Middle Name:LYNN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1186 PORTSMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:PEEBLES
Mailing Address - State:OH
Mailing Address - Zip Code:45660-8919
Mailing Address - Country:US
Mailing Address - Phone:937-798-4010
Mailing Address - Fax:
Practice Address - Street 1:1186 PORTSMOUTH RD
Practice Address - Street 2:
Practice Address - City:PEEBLES
Practice Address - State:OH
Practice Address - Zip Code:45660-8919
Practice Address - Country:US
Practice Address - Phone:937-798-4010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2712532Medicaid