Provider Demographics
NPI:1821571753
Name:SHAFER, LUPE (RN, PNP, MSN)
Entity Type:Individual
Prefix:
First Name:LUPE
Middle Name:
Last Name:SHAFER
Suffix:
Gender:F
Credentials:RN, PNP, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9121 ROAD 240
Mailing Address - Street 2:
Mailing Address - City:TERRA BELLA
Mailing Address - State:CA
Mailing Address - Zip Code:93270-9423
Mailing Address - Country:US
Mailing Address - Phone:559-535-4451
Mailing Address - Fax:
Practice Address - Street 1:9121 ROAD 240
Practice Address - Street 2:
Practice Address - City:TERRA BELLA
Practice Address - State:CA
Practice Address - Zip Code:93270-9423
Practice Address - Country:US
Practice Address - Phone:559-535-4451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA350407163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool