Provider Demographics
NPI:1871803791
Name:SHILTS, THOMAS WILFRED (RN)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:WILFRED
Last Name:SHILTS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:M225 TURTLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-9285
Mailing Address - Country:US
Mailing Address - Phone:715-387-2080
Mailing Address - Fax:715-387-2080
Practice Address - Street 1:M225 TURTLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-9285
Practice Address - Country:US
Practice Address - Phone:715-387-2080
Practice Address - Fax:715-387-2080
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI122136-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse