Deanna Adol Shaffer

Primary specialty

Administrator Registered NurseTaxonomy code 163WA2000X

License

RN180622 Issued in OH

Practice address

100 Pinnacle Dr
Fremont, OH 43420-7400

Phone

(419) 332-0310

Fax

(419) 332-0296

NPI assigned

Nov 15, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kinswa Dialysis LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fremont, OH
  • NPI 1124380456
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1636934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636934400000",
    "number": "1407512437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PINNACLE DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434207400",
            "telephone_number": "419-332-0310",
            "fax_number": "419-332-0296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PINNACLE DR",
            "city": "FREMONT",
            "state": "OH",
            "postal_code": "434207400",
            "telephone_number": "419-332-0310",
            "fax_number": "419-332-0296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "DEANNA",
        "middle_name": "ADOL",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-15",
        "last_updated": "2021-11-15",
        "certification_date": "2021-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WA2000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Administrator",
            "state": "OH",
            "license": "RN180622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36-2791",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Lynn Schwan, LISWS
• Lacelle Schwochow, ED. S.
• Erin M Scott, PT
• Rachael Scott
• Mark W. Seymour, P.C.C.
• Sabeeha Naazneen Shaik, MD
• Lucas Tyler Shammo, FNP-C
• Paige Rochelle Shane, PTA
• Shai Yeshajahu Shinhar, MD
• Kelly Renee Shoborn, STNA

• Administrator Registered Nurse in Fremont, OH
• Providers in Fremont, OH by specialty
• Administrator Registered Nurse in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.