Mary Ellen Shields, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD00017067 Issued in WA

Practice address

6760 Mission Rd
Everson, WA 98247-9749

Phone

(360) 966-2106

Fax

(360) 966-2304

NPI assigned

Jan 8, 2007

Last updated

Mar 31, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nooksack Central Management System

  • Family Medicine Physician
  • Everson, WA
  • NPI 1568528842
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1932257144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6760 MISSION RD",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982479749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6760 MISSION RD",
            "city": "EVERSON",
            "state": "WA",
            "postal_code": "982479749",
            "telephone_number": "360-966-2106",
            "fax_number": "360-966-2304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIELDS",
        "first_name": "MARY",
        "middle_name": "ELLEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WA",
            "license": "MD00017067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janiece Sandwater, RN60483287
• Michele Jean Schuster, MED
• Sea Mar Community Health Centers
• Sea-Mar Community Health Center
• Sara L. Sheaffer, D.O.
• Deanna Sloane, CCC-SLP
• Diane R Staves, M.D.
• Sandra L Stork, RC
• Paula Renae Stratman
• Shaye Swannack

• Pediatrics Physician in Everson, WA
• Providers in Everson, WA by specialty
• Pediatrics Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.