Individual
JOHN WAYNE SHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
500 W FRONT ST, BOISE, ID 83702-7231
(208) 422-1000
Mailing address
500 W FRONT ST, BOISE, ID 83702-7231
(208) 422-1000
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
54544
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54544
VETERANS ADMINISTRATION
ID
Enumeration date
08/28/2020
Last updated
08/28/2020
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