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Individual

JOHN SHAVER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
FNP

Contact information

Practice address
2600 LAFRANIER RD, TRAVERSE CITY, MI 49686-4765
(231) 995-6111
Mailing address
2600 LAFRANIER RD, TRAVERSE CITY, MI 49686-4765

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704339651
MI
363LF0000X
Family Nurse Practitioner
Primary
71009970A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
4704339651
LICENSING AND REGULATORY AFFAIRS
MI
01
71009970A
INDIANA PROFESSIONAL LICENSING AGENCY
IN
Enumeration date
04/14/2020
Last updated
05/02/2023
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