Provider Demographics
NPI:1871829135
Name:SHIELDS, ALEXIS D (ND)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:D
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 SE 86TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-1338
Mailing Address - Country:US
Mailing Address - Phone:317-408-2959
Mailing Address - Fax:
Practice Address - Street 1:7817 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2339
Practice Address - Country:US
Practice Address - Phone:317-408-2959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1699175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath