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NPI Code Detail

MEDICARE: MS. MARY J SHAFFER NP

MEDICARE: MS. MARY J SHAFFER NP
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
1363LA2200XAdult Health Nurse Practitioner63257CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912061466
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY J SHAFFER NP
Provider Business Mailing Address
First Line : 3205 N ACADEMY BLVD
Second Line : SUITE 130
City : COLORADO SPRINGS
State : CO
Zip : 80917-5101
Country : US
Telephone Number : 719-632-5700
Fax Number :
Provider Business Practice Location Address
First Line : 722 S WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4035
Country : US
Telephone Number : 719-632-5700
Fax Number : 719-344-7828
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 04/05/2017

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