Provider Demographics
NPI:1760971550
Name:SHIELD, KATHERINE V
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:V
Last Name:SHIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATHERINE
Other - Middle Name:V
Other - Last Name:MCNULTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:CHEHALIS FAMILY MEDICINE
Mailing Address - Street 2:931 S. MARKET BLVD
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532
Mailing Address - Country:US
Mailing Address - Phone:360-767-6300
Mailing Address - Fax:360-767-6320
Practice Address - Street 1:931 S. MARKET BLVD
Practice Address - Street 2:931 S. MARKET BLVD
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532
Practice Address - Country:US
Practice Address - Phone:360-767-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAML60863372207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine