Basic Information
| Provider Information | |||||||||
| NPI: | 1760971550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHIELD | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MCNULTY | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | V | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | CHEHALIS FAMILY MEDICINE | ||||||||
| Address2: | 931 S. MARKET BLVD | ||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607676300 | ||||||||
| FaxNumber: | 3607676320 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 S. MARKET BLVD | ||||||||
| Address2: | 931 S. MARKET BLVD | ||||||||
| City: | CHEHALIS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3607676300 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 11/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ML60863372 | WA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.