Basic Information
| Provider Information | |||||||||
| NPI: | 1568812469 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAFFER | ||||||||
| FirstName: | LINDSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3923 MERCY DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600503173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153445061 | ||||||||
| FaxNumber: | 8153445072 | ||||||||
| Practice Location | |||||||||
| Address1: | 3923 MERCY DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600503173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153445061 | ||||||||
| FaxNumber: | 8153445072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2016 | ||||||||
| LastUpdateDate: | 06/21/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 164.006847 | IL | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.