Provider Demographics
NPI:1770673873
Name:SHIELDS, CATHERINE R (CNM)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:R
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:R
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:7100 COMMERCE WAY
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2829
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1603 N BELT ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4038
Practice Address - Country:US
Practice Address - Phone:509-473-7060
Practice Address - Fax:509-326-0521
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003483367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9613852Medicaid
WA9613852Medicaid
WA8858274Medicare PIN
WAQ62693Medicare UPIN