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General NPI Number Information
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NPI Number | 1881419604
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Entity Type | Individual
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Provider Name | HEIDI MARIE SHAFER PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/18/2024
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Last Update Date | 11/18/2024
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Provider Practice Location Address
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Address Line | 612 WASHINGTON BLVD
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City | BELPRE
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State | OH
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Zip | 45714-2465
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Country | US
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Telephone | 740-315-1065
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Fax |
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Provider Business Mailing Address
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Address Line | 500 BUFFALO TOM DR
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City | GREENSBORO
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State | NC
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Zip | 27455-8344
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Country | US
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Telephone | 770-905-3779
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1219220
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License Number State |
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