Provider Demographics
NPI:1093793291
Name:SCHAFER, MARY S (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:S
Last Name:SCHAFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2764 COMPASS DR STE 229
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-8722
Mailing Address - Country:US
Mailing Address - Phone:970-549-0757
Mailing Address - Fax:
Practice Address - Street 1:2764 COMPASS DR
Practice Address - Street 2:2764 COMPASS DR
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-8743
Practice Address - Country:US
Practice Address - Phone:970-549-0757
Practice Address - Fax:970-433-7624
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COC-APN.0000758-C-NP363LP0808X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ970386Medicaid
MS1110270OtherDEA