Provider Demographics
NPI:1407512437
Name:SHAFFER, DEANNA ADOL
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:ADOL
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PINNACLE DR
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-7400
Mailing Address - Country:US
Mailing Address - Phone:419-332-0310
Mailing Address - Fax:419-332-0296
Practice Address - Street 1:100 PINNACLE DR
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-7400
Practice Address - Country:US
Practice Address - Phone:419-332-0310
Practice Address - Fax:419-332-0296
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN180622163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH36-2791Medicaid