Provider Demographics
NPI:1902818115
Name:SCHAFFER, JUDY MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:MARIE
Last Name:SCHAFFER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 NE 8TH ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-7317
Mailing Address - Country:US
Mailing Address - Phone:503-988-3663
Mailing Address - Fax:503-988-4098
Practice Address - Street 1:421 SW OAK ST
Practice Address - Street 2:210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-1817
Practice Address - Country:US
Practice Address - Phone:503-988-3663
Practice Address - Fax:503-988-4098
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR080046279N1FNPPP146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500008420OtherUNITED HEALTHCARE
OR291674Medicaid
OR291674Medicaid
OR500008420OtherUNITED HEALTHCARE
OR104483Medicare ID - Type Unspecified