Provider Demographics
NPI:1891769592
Name:SHIELDS, JOAN MARIE (PA)
Entity Type:Individual
Prefix:MS
First Name:JOAN
Middle Name:MARIE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 ELM ST N
Mailing Address - Street 2:
Mailing Address - City:ONAMIA
Mailing Address - State:MN
Mailing Address - Zip Code:56359-7901
Mailing Address - Country:US
Mailing Address - Phone:320-532-3154
Mailing Address - Fax:320-532-3111
Practice Address - Street 1:200 ELM ST N
Practice Address - Street 2:
Practice Address - City:ONAMIA
Practice Address - State:MN
Practice Address - Zip Code:56359-7901
Practice Address - Country:US
Practice Address - Phone:320-532-3154
Practice Address - Fax:320-532-3111
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9051363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN01-13466OtherMEDICA ISLE
MNHP20623OtherHEALTH PARTNERS
MN01-13465OtherMEDICA HILLMAN
ND18358OtherMEDICAID
MN831785200Medicaid
MN485T0SHOtherBLUE CROSS CLINIC
MNNA9091004444OtherPREFERED ONE
MN01-13458OtherMEDICA ONAMIA CLINIC
MN06F16SHOtherBLUE CROSS HOSPITAL
MN115811OtherUCARE
MN831785200Medicaid
MN01-13465OtherMEDICA HILLMAN
MNHP20623OtherHEALTH PARTNERS
MN970001595Medicare Oscar/Certification
MN01-13466OtherMEDICA ISLE
S21789Medicare UPIN
MN970000507Medicare Oscar/Certification