Provider Demographics
NPI:1124502216
Name:SHAFFERMAN, MADELEIN C (NMD)
Entity type:Individual
Prefix:DR
First Name:MADELEIN
Middle Name:C
Last Name:SHAFFERMAN
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 W EMERALD ST STE 203
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8660
Mailing Address - Country:US
Mailing Address - Phone:208-806-1332
Mailing Address - Fax:208-907-5215
Practice Address - Street 1:6901 W EMERALD ST STE 203
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8660
Practice Address - Country:US
Practice Address - Phone:208-806-1332
Practice Address - Fax:208-907-5215
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ18-1731175F00000X
IDNMD-0045175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ18-1731OtherARIZONA NATUROPATHIC MEDICAL BOARD
IDNMD-0045OtherIDAHO BOARD OF MEDICINE