Healthcare Provider Details

I. General information

NPI: 1104459262
Provider Name (Legal Business Name): JULIE SHAFFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 N LIME ST
LANCASTER PA
17602-2337
US

IV. Provider business mailing address

10 CRIMSON LN
LITITZ PA
17543-7986
US

V. Phone/Fax

Practice location:
  • Phone: 717-696-9627
  • Fax:
Mailing address:
  • Phone: 717-823-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN660851
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: