Individual
JENNIFER DAWN SHAFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
5604 E WHITE OAK LN, MARENGO, IN 47140-8413
(812) 365-3221
(812) 365-9502
Mailing address
420 W LONGEST ST, PAOLI, IN 47454-8821
(812) 723-3944
(812) 723-7991
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28168433A
IN
363LF0000X
Family Nurse Practitioner
Primary
71004086A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201110950
—
IN
Enumeration date
08/16/2012
Last updated
12/10/2020
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