Healthcare Provider Details

I. General information

NPI: 1760717367
Provider Name (Legal Business Name): JESSE GERALD SCHAFFER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2009
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S HUDSON ST
SILVER CITY NM
88061-6184
US

IV. Provider business mailing address

PO BOX 1349
SILVER CITY NM
88062-1349
US

V. Phone/Fax

Practice location:
  • Phone: 575-388-4497
  • Fax: 575-534-1150
Mailing address:
  • Phone: 575-388-4412
  • Fax: 575-534-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR58756
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: