Provider Demographics
NPI:1780649046
Name:SCHAFFER, MARY J (ARNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W ROSS BLVD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2131
Mailing Address - Country:US
Mailing Address - Phone:620-225-1650
Mailing Address - Fax:620-227-2505
Practice Address - Street 1:120 W ROSS BLVD
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2131
Practice Address - Country:US
Practice Address - Phone:620-225-1650
Practice Address - Fax:620-227-2505
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74290363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner