Basic Information
| Provider Information | |||||||||
| NPI: | 1275504425 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFFER | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | LE ALAN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 911 ROBINSON AVE | ||||||||
| Address2: | |||||||||
| City: | TRINIDAD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 810822811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198454884 | ||||||||
| FaxNumber: | 7198468209 | ||||||||
| Practice Location | |||||||||
| Address1: | 1105 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | ARTESIA | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5757469848 | ||||||||
| FaxNumber: | 5757462215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 59325 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.