Provider Demographics
NPI:1639735616
Name:SHIELDS, JULIE RENEE (NP)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:RENEE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:JULIE
Other - Middle Name:RENEE
Other - Last Name:ROMASKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:487 OBRYAN LN
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-8805
Mailing Address - Country:US
Mailing Address - Phone:406-471-9025
Mailing Address - Fax:
Practice Address - Street 1:350 HERITAGE WAY STE 2300
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3167
Practice Address - Country:US
Practice Address - Phone:406-752-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-131696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health