MEDICARE: SHAFER ANESTHESIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist

General Provider Information

NPI Number	:	1093300691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAFER ANESTHESIA, LLC

Provider Business Mailing Address
First Line	:	710 E BELLE LN
Second Line	:
City	:	COLBERT
State	:	WA
Zip	:	99005-5122
Country	:	US
Telephone Number	:	208-866-1568
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 N PINES RD
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4942
Country	:	US
Telephone Number	:	208-866-1568
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL SHAFER
Credential	:	CRNA
Telephone Number	:	208-866-1568

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/15/2021

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Directions to “SHAFER ANESTHESIA, LLC ” Practice Location

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