Provider Demographics
NPI:1689819500
Name:SHAFER, BRENDA M (ARNP, NNP-BC)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:M
Last Name:SHAFER
Suffix:
Gender:F
Credentials:ARNP, NNP-BC
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:M
Other - Last Name:HEDDENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2296
Mailing Address - Fax:319-356-4855
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2296
Practice Address - Fax:319-356-4855
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAK101615363LN0005X
IA101615K363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI0923143Medicare PIN