Provider Demographics
NPI:1770554479
Name:SHAFFER, NANCY J (CRNA)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8804 SUNDANCE PLACE CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4217
Mailing Address - Country:US
Mailing Address - Phone:817-228-2531
Mailing Address - Fax:
Practice Address - Street 1:8804 SUNDANCE PLACE CT
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-4217
Practice Address - Country:US
Practice Address - Phone:817-228-2531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX235842367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84054UOtherBCBS
OK200020770AMedicaid
TX006856104Medicaid
TX006856107Medicaid
TX83824UOtherBCBS
OKOKA102355Medicare PIN
TX8K0737Medicare PIN
TX84054UOtherBCBS