Active NPI
John Wayne Shaffer, LPN
- Licensed Practical Nurse
- Boise, ID
National Provider Identifier
1396358438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- 54544
- Practice address
- 500 W Front St
Boise, ID 83702-7231 - Phone
- (208) 422-1000
- NPI assigned
- Aug 28, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 54544 | ID | Primary |
Addresses
Primary practice location
500 W Front St
Boise, ID 83702-7231
Mailing address
500 W Front St
Boise, ID 83702-7231
Phone (208) 422-1000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54544 | Other | ID | VETERANS ADMINISTRATION |
| 54544 | Other | ID | IDAHO BAORD OF NURSING |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54544 | ID | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1598572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598572800000",
"number": "1396358438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 W FRONT ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837027231",
"telephone_number": "208-422-1000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W FRONT ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837027231",
"telephone_number": "208-422-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAFFER",
"first_name": "JOHN",
"middle_name": "WAYNE",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-28",
"last_updated": "2020-08-28",
"certification_date": "2020-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "ID",
"license": "54544",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VETERANS ADMINISTRATION",
"identifier": "54544",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO BAORD OF NURSING",
"identifier": "54544",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.