Provider Demographics
NPI:1295896769
Name:SHAVER, BARBARA A (CRNP)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:A
Last Name:SHAVER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9683A MAIN ST
Mailing Address - Street 2:WOODSON FAMILY PRACTICE
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-3744
Mailing Address - Country:US
Mailing Address - Phone:703-426-4900
Mailing Address - Fax:703-426-4955
Practice Address - Street 1:9683-A MAIN ST
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3744
Practice Address - Country:US
Practice Address - Phone:703-426-4900
Practice Address - Fax:703-426-4955
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024162231363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
P65163Medicare UPIN
500001127Medicare ID - Type Unspecified