| Doctor Name: | MARY SHIELDS |
| NPI Number: | 1033139910 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP |
| License Number: | R0790556 |
| Business Practice Address: | 3366 Oakdale Ave N Suite 551 Robbinsdale, MN - 554222948 |
| Business Phone Number: | 7635877737 |
| Business Fax Number: | 7635877069 |
| Mailing Address: | 9201 W Broadway Ave, Suite 601 BROOKLYN PARK |
| State: | MN |
| Postal Code: | 554451923 |
| Phone Number: | 7635877900 |
| Fax Number: | 7635877069 |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 10/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LG0600X |
| License Number: | R0790556 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Gerontology |
| Taxonomy Definition: | |