Provider Demographics
NPI:1396567525
Name:SHAFFER, HEATHER ANN (RN BSN)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:ANN
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 POPLAR LN
Mailing Address - Street 2:
Mailing Address - City:PORTERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16051-2136
Mailing Address - Country:US
Mailing Address - Phone:724-421-7190
Mailing Address - Fax:
Practice Address - Street 1:120 POPLAR LN
Practice Address - Street 2:
Practice Address - City:PORTERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:16051-2136
Practice Address - Country:US
Practice Address - Phone:724-421-7190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN502367L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse