Provider Demographics
NPI:1720410012
Name:SCHAFFER, SCOTT BRADLEY (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BRADLEY
Last Name:SCHAFFER
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5233 CANTERBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-4954
Mailing Address - Country:US
Mailing Address - Phone:208-850-9125
Mailing Address - Fax:
Practice Address - Street 1:210 W BURNSIDE AVE STE D
Practice Address - Street 2:
Practice Address - City:CHUBBUCK
Practice Address - State:ID
Practice Address - Zip Code:83202-4916
Practice Address - Country:US
Practice Address - Phone:208-850-9125
Practice Address - Fax:208-213-1122
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1299A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily