Provider Demographics
NPI:1881880839
Name:SHAFER, TRACY A (NP)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:A
Last Name:SHAFER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 W BLUEWATER HWY
Mailing Address - Street 2:E BLD, RM 31
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-8553
Mailing Address - Country:US
Mailing Address - Phone:616-527-3100
Mailing Address - Fax:
Practice Address - Street 1:1728 W BLUEWATER HWY
Practice Address - Street 2:E BLD, RM 31
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-8553
Practice Address - Country:US
Practice Address - Phone:616-527-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2007-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704157352363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily