Provider Demographics
NPI:1720587561
Name:SHAFFER, CATHLEEN ERIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CATHLEEN
Middle Name:ERIN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:ERIN
Other - Last Name:REILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1911
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-0919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2712 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:JULIAN
Practice Address - State:CA
Practice Address - Zip Code:92036
Practice Address - Country:US
Practice Address - Phone:619-277-6183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008499363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95008499OtherBOARD OF REGISTERED NURSES