Healthcare Provider Details

I. General information

NPI: 1588006522
Provider Name (Legal Business Name): PENNY SHAFFER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2013
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 HOSPITAL PKWY
BEATRICE NE
68310-6906
US

IV. Provider business mailing address

4800 HOSPITAL PKWY
BEATRICE NE
68310-6906
US

V. Phone/Fax

Practice location:
  • Phone: 402-223-6518
  • Fax: 402-223-6565
Mailing address:
  • Phone: 402-223-6518
  • Fax: 402-223-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number111465
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: