MEDICARE: BRIGITTE SHAFFER NP-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
1	363LF0000X	Family Nurse Practitioner	2017040106	MO

General Provider Information

NPI Number	:	1407352594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIGITTE SHAFFER NP-C

Provider Business Mailing Address
First Line	:	HC 1 BOX 1855
Second Line	:
City	:	LODI
State	:	MO
Zip	:	63950-9702
Country	:	US
Telephone Number	:	573-944-0789
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 S SAM HOUSTON BLVD
Second Line	:
City	:	HOUSTON
State	:	MO
Zip	:	65483-2130
Country	:	US
Telephone Number	:	417-967-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2018
Last Update Date	:	04/05/2018

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Directions to “ BRIGITTE SHAFFER NP-C” Practice Location

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