Healthcare Provider Details

I. General information

NPI: 1376216549
Provider Name (Legal Business Name): ELIZABETH MARIE SHAFFER AGACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2021
Last Update Date: 01/02/2023
Certification Date: 01/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6100 WHIPPLE AVE NW
CANTON OH
44720-7618
US

IV. Provider business mailing address

PO BOX 80690
CANTON OH
44708-0690
US

V. Phone/Fax

Practice location:
  • Phone: 330-363-7444
  • Fax: 330-363-7770
Mailing address:
  • Phone: 330-363-7444
  • Fax: 330-363-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0028902
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: