Provider Demographics
NPI:1710642624
Name:SHIFERAW, WASIHUN SITNATYEHU (CRNP)
Entity Type:Individual
Prefix:
First Name:WASIHUN
Middle Name:SITNATYEHU
Last Name:SHIFERAW
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 1:237 GREENLAND DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-3351
Mailing Address - Country:US
Mailing Address - Phone:317-361-7159
Mailing Address - Fax:
Practice Address - Street 1:417 W FREDERICK ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-2804
Practice Address - Country:US
Practice Address - Phone:717-381-4320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021915363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care