Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | AP136764 | TX |
NPI | 1033610969 |
---|---|
Provider Name | Summer Renee Shields |
First Address | Conroe, TX 77385-3824 |
Second Address | Shenandoah, TX 77380 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2018 |
Last Update Date | 05/07/2018 |