Provider Demographics
NPI:1942291927
Name:SHIELDS, SAN CURTIS (CNP)
Entity Type:Individual
Prefix:MR
First Name:SAN
Middle Name:CURTIS
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:CNP
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Mailing Address - Street 1:540 WALTON BLVD STE C
Mailing Address - Street 2:NEW URGENT CARE
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8433
Mailing Address - Country:US
Mailing Address - Phone:575-525-2700
Mailing Address - Fax:575-521-0793
Practice Address - Street 1:530 N TELSHOR . STE. C
Practice Address - Street 2:LAS CRUCES QUICK CARE
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:575-532-2004
Practice Address - Fax:575-532-2441
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2012-02-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NMR24296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM341401506Medicare PIN
S78951Medicare UPIN