Provider Demographics
NPI:1700220332
Name:RUSSELL-SHAFFER, RAINA (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:RAINA
Middle Name:
Last Name:RUSSELL-SHAFFER
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 MURRAY DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-3339
Mailing Address - Country:US
Mailing Address - Phone:209-373-2800
Mailing Address - Fax:
Practice Address - Street 1:7210 MURRAY DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3339
Practice Address - Country:US
Practice Address - Phone:209-373-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-25
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22869363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily