Provider Demographics
NPI:1639422470
Name:SHAFER, JAMIE EILEEN (PA-C)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:EILEEN
Last Name:SHAFER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 SADDLE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-8645
Mailing Address - Country:US
Mailing Address - Phone:406-204-2409
Mailing Address - Fax:406-422-5611
Practice Address - Street 1:3116 SADDLE DR STE 4
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-8645
Practice Address - Country:US
Practice Address - Phone:406-204-2409
Practice Address - Fax:406-422-5611
Is Sole Proprietor?:No
Enumeration Date:2012-10-17
Last Update Date:2025-03-18
Deactivation Date:2025-03-04
Deactivation Code:
Reactivation Date:2025-03-17
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-19990363A00000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant