Provider Demographics
NPI:1982281143
Name:SHIELDS-HAAS, VANESSA (FNP-C)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SHIELDS-HAAS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3237
Mailing Address - Country:US
Mailing Address - Phone:703-459-8692
Mailing Address - Fax:
Practice Address - Street 1:22 WHITE STREET
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2978
Practice Address - Country:US
Practice Address - Phone:207-922-3222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECPC211030363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily