Individual
NICOLE ELIZABETH SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
8040 CLEARVISTA PARKWAY, SUITE 460, INDIANAPOLIS, IN 46256-5630
(317) 621-2660
(317) 621-1535
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
71002493B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201139570
—
IN
01
—
P01424401
RR MEDICARE
IN
Enumeration date
09/05/2008
Last updated
11/27/2023
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