Provider Demographics
NPI:1962773606
Name:SHAVER, LAUREN YETZER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:YETZER
Last Name:SHAVER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EMPORIUM
Mailing Address - State:PA
Mailing Address - Zip Code:15834-1302
Mailing Address - Country:US
Mailing Address - Phone:814-486-1115
Mailing Address - Fax:814-486-0404
Practice Address - Street 1:90 E 2ND ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1302
Practice Address - Country:US
Practice Address - Phone:814-486-1115
Practice Address - Fax:814-486-0404
Is Sole Proprietor?:No
Enumeration Date:2012-01-25
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA002769363A00000X
PAMA055289363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant