Provider Demographics
NPI:1871326744
Name:SHAFFER, TARA RODGERS (RN, CLWT)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:RODGERS
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:RN, CLWT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 EAGLES NEST LN
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-1443
Mailing Address - Country:US
Mailing Address - Phone:615-686-8262
Mailing Address - Fax:
Practice Address - Street 1:18 EAGLES NEST LN
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-1443
Practice Address - Country:US
Practice Address - Phone:615-686-8262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC319116163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice