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NPI Code Detail

MEDICARE: MRS. KRISTEN G SHAFFER FNP-C

MEDICARE: MRS. KRISTEN G SHAFFER FNP-C
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
1363LF0000XFamily Nurse Practitioner101.0097262VT
2363LF0000XFamily Nurse Practitioner201402108NP-PPOR

General Provider Information

NPI Number : 1164772893
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTEN G SHAFFER FNP-C
Provider Business Mailing Address
First Line : 5048 SE KNAPP ST
Second Line :
City : PORTLAND
State : OR
Zip : 97206-8342
Country : US
Telephone Number : 415-516-6143
Fax Number : 877-767-3163
Provider Business Practice Location Address
First Line : 4550 KRUSE WAY STE 125
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-3533
Country : US
Telephone Number : 503-457-7100
Fax Number : 877-767-3163
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2012
Last Update Date : 10/23/2023

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