Provider Demographics
NPI:1275504425
Name:SHAFFER, ROBERT LE ALAN (FNP)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LE ALAN
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:911 ROBINSON AVE
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2811
Mailing Address - Country:US
Mailing Address - Phone:719-845-4884
Mailing Address - Fax:719-846-8209
Practice Address - Street 1:1105 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1189
Practice Address - Country:US
Practice Address - Phone:575-746-9848
Practice Address - Fax:575-746-2215
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO59325363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily