Provider Demographics
NPI:1114668068
Name:SHAFFER, LARYNN REBECCA (RN)
Entity Type:Individual
Prefix:MRS
First Name:LARYNN
Middle Name:REBECCA
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 CROOKED STUMP RD
Mailing Address - Street 2:
Mailing Address - City:TERRA ALTA
Mailing Address - State:WV
Mailing Address - Zip Code:26764-6209
Mailing Address - Country:US
Mailing Address - Phone:304-698-5541
Mailing Address - Fax:
Practice Address - Street 1:30 MON GENERAL DR STE 2
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2853
Practice Address - Country:US
Practice Address - Phone:304-598-5151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV82938163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse