Provider Demographics
NPI:1609215425
Name:SHIELDS, DENISE LYNN (ACNP-BC, CRNP)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:LYNN
Last Name:SHIELDS
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Gender:F
Credentials:ACNP-BC, CRNP
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Mailing Address - Street 1:3400 CIVIC CENTER BLVD
Mailing Address - Street 2:2 EAST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5127
Mailing Address - Country:US
Mailing Address - Phone:215-615-4949
Mailing Address - Fax:215-615-0829
Practice Address - Street 1:3400 CIVIC CENTER BLVD
Practice Address - Street 2:2 EAST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-5127
Practice Address - Country:US
Practice Address - Phone:215-615-4949
Practice Address - Fax:215-615-0829
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2019-12-30
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Provider Licenses
StateLicense IDTaxonomies
PASP012830363LA2100X
NJ26NJ00420800363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care