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NPI Code Detail

MEDICARE: WHITNEY J. SHAFER NP

MEDICARE: WHITNEY J. SHAFER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN.CNP.0040834OH
2363L00000XNurse Practitioner71005021AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1598173056
Entity Type Code : Individual
Provider Name (Legal Business Name) : WHITNEY J. SHAFER NP
Provider Business Mailing Address
First Line : 11109 PARKVIEW PLAZA DR # 117
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1701
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3909 NEW VISION DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1725
Country : US
Telephone Number : 260-425-5500
Fax Number : 260-425-5525
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/29/2014
Last Update Date : 03/30/2026

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