Provider Demographics
NPI:1326341231
Name:SHAFFER, DELORES JEAN (LPN)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:JEAN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:MS
Other - First Name:DEE
Other - Middle Name:J
Other - Last Name:SHAFFER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPN
Mailing Address - Street 1:150 SOUTH 31ST STREET
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68003-1048
Mailing Address - Country:US
Mailing Address - Phone:402-802-2479
Mailing Address - Fax:
Practice Address - Street 1:150 SOUTH 31ST STREET
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NE
Practice Address - Zip Code:68003-1048
Practice Address - Country:US
Practice Address - Phone:402-802-2479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5280164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse