Individual
JACKLYN SCHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Mailing address
2514 E DUPONT RD STE 100, FORT WAYNE, IN 46825-1619
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28191291A
IN
363L00000X
Nurse Practitioner
Primary
71005316A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0120115
—
OH
05
—
201273240
—
IN
Enumeration date
10/14/2014
Last updated
05/06/2020
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