Provider Demographics
NPI:1083055602
Name:SHAFFER, BETSY LE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:LE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8610 NORTHBLUFF LN
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8084
Mailing Address - Country:US
Mailing Address - Phone:614-406-5809
Mailing Address - Fax:
Practice Address - Street 1:112 MOREY DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-1646
Practice Address - Country:US
Practice Address - Phone:937-578-4281
Practice Address - Fax:937-578-2858
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14716-NP363LF0000X
OHAPRN.CNP.14716363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily