Individual
KATHLEEN A SCHAFFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 266-2020
(260) 266-2009
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 266-2020
(260) 266-2009
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71005311A
IN
363LF0000X
Family Nurse Practitioner
COA11467NP
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3138590
—
OH
01
—
SCNP37971
MEDICARE PTAN
OH
Enumeration date
09/21/2010
Last updated
01/19/2015
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