Healthcare Provider Details

I. General information

NPI: 1649970898
Provider Name (Legal Business Name): CINDY J SHAFFER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2023
Last Update Date: 03/07/2023
Certification Date: 03/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE JACOB ST
GRIMES IA
50111-2003
US

IV. Provider business mailing address

3600 30TH ST
DES MOINES IA
50310-5753
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5550
  • Fax: 515-699-5710
Mailing address:
  • Phone: 515-699-5550
  • Fax: 515-699-5710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number116236
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: