Healthcare Provider Details

I. General information

NPI: 1588723522
Provider Name (Legal Business Name): NANCY SHAFFER ESGROW NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CRESTWOOD RD
CORNING NY
14830-3331
US

IV. Provider business mailing address

2 CRESTWOOD RD
CORNING NY
14830-3331
US

V. Phone/Fax

Practice location:
  • Phone: 607-936-9278
  • Fax:
Mailing address:
  • Phone: 607-936-9278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number331705-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: