Provider Demographics
NPI:1841870920
Name:SHAFER, JEAN A (RN)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:A
Last Name:SHAFER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 PEGGY LN
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-1456
Mailing Address - Country:US
Mailing Address - Phone:215-817-2625
Mailing Address - Fax:
Practice Address - Street 1:125 TITUS AVE
Practice Address - Street 2:
Practice Address - City:WARRINGTON
Practice Address - State:PA
Practice Address - Zip Code:18976-2424
Practice Address - Country:US
Practice Address - Phone:267-487-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN604924163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse