Provider Demographics
NPI:1730809617
Name:SHAVER, EMILY ELIZABETH (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:SHAVER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ELIZABETH
Other - Last Name:ROY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:58750 SUN VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46528-7788
Mailing Address - Country:US
Mailing Address - Phone:574-855-6191
Mailing Address - Fax:
Practice Address - Street 1:1155 N 1200 W
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9372
Practice Address - Country:US
Practice Address - Phone:574-825-3888
Practice Address - Fax:574-318-3358
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013001A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily