Provider Demographics
NPI:1629611488
Name:HAFER, SHANE M (CRNP)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:M
Last Name:HAFER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19605-1405
Mailing Address - Country:US
Mailing Address - Phone:484-529-7443
Mailing Address - Fax:
Practice Address - Street 1:3600 CIVIC CENTER BLVD FL 3
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4310
Practice Address - Country:US
Practice Address - Phone:215-662-6187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020954363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care