MEDICARE: LISA SHAFFER

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	3747A0650X	Attendant Care Provider

General Provider Information

NPI Number	:	1760091821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA SHAFFER

Provider Business Mailing Address
First Line	:	360 WHEELER HILL DR
Second Line	:
City	:	LAHMANSVILLE
State	:	WV
Zip	:	26731-5696
Country	:	US
Telephone Number	:	304-851-4230
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 MAPLE HILL AVE STE 1
Second Line	:
City	:	PETERSBURG
State	:	WV
Zip	:	26847-1547
Country	:	US
Telephone Number	:	304-257-9298
Fax Number	:

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

Provider Enumeration Date	:	07/24/2020
Last Update Date	:	07/24/2020

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Directions to “ LISA SHAFFER ” Practice Location

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