Healthcare Provider Details

I. General information

NPI: 1053080036
Provider Name (Legal Business Name): JULIE SHAFFER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2021
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11426 N 134TH EAST AVE
OWASSO OK
74055-4715
US

IV. Provider business mailing address

10757 E 350 RD
TALALA OK
74080-9689
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2273
  • Fax:
Mailing address:
  • Phone: 918-688-2823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number204871
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: