Provider Demographics
NPI:1699290718
Name:SHAFER, MARY BETH (DNP, FNP-BC, CPN)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:BETH
Last Name:SHAFER
Suffix:
Gender:F
Credentials:DNP, FNP-BC, CPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1290 SILAS DEANE HWY
Mailing Address - Street 2:HARTFORD HEALTHCARE-CVO
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1215 WILBRAHAM RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01119-2612
Practice Address - Country:US
Practice Address - Phone:413-782-1211
Practice Address - Fax:413-796-2255
Is Sole Proprietor?:No
Enumeration Date:2017-08-09
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT7150363LF0000X, 363LP2300X
MARN2263064363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care