Healthcare Provider Details

I. General information

NPI: 1730775883
Provider Name (Legal Business Name): NIKKI M SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/09/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 PARK AVE
IRONTON OH
45638-1502
US

IV. Provider business mailing address

6400 E BROAD ST STE 400
COLUMBUS OH
43213-2979
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1613
  • Fax: 740-879-0599
Mailing address:
  • Phone: 614-655-3345
  • Fax: 614-317-4689

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.175187
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.179160
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: