Provider Demographics
NPI:1205645553
Name:SHIELDS, CALEB LE ASHTON (RN)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:LE ASHTON
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N FAIRFIELD RD
Mailing Address - Street 2:BOX 133
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-0915
Mailing Address - Country:US
Mailing Address - Phone:385-232-3733
Mailing Address - Fax:
Practice Address - Street 1:1123 E 1100 N
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84040-2841
Practice Address - Country:US
Practice Address - Phone:385-232-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-02
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98367903102163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse