Provider Demographics
NPI:1619291200
Name:SHAFNER, LUCY J
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:J
Last Name:SHAFNER
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 1:6490 S MCCARRAN BLVD
Mailing Address - Street 2:SUITE B-15
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6165
Mailing Address - Country:US
Mailing Address - Phone:775-247-3710
Mailing Address - Fax:
Practice Address - Street 1:6490 S MCCARRAN BLVD
Practice Address - Street 2:SUITE B-15
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6165
Practice Address - Country:US
Practice Address - Phone:775-247-3710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3507225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist