Provider Demographics
NPI:1205136207
Name:SHIELDS, ANDREA LEE (CNP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:LEE
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 AUTUMN WIND DR
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-7579
Mailing Address - Country:US
Mailing Address - Phone:614-307-2499
Mailing Address - Fax:
Practice Address - Street 1:2245 N BANK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-5422
Practice Address - Country:US
Practice Address - Phone:614-593-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 11824-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081056Medicaid
OH0081056Medicaid