Provider Demographics
NPI:1679246599
Name:SHIELDS, ELIZABETH JANE
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14321 WOOD VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-2131
Mailing Address - Country:US
Mailing Address - Phone:402-217-6880
Mailing Address - Fax:
Practice Address - Street 1:11640 ARBOR ST STE 101
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5007
Practice Address - Country:US
Practice Address - Phone:402-217-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health