Basic Information
| Provider Information | |||||||||
| NPI: | 1235296013 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAFFO | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | LYNNE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2421 SILVER STREAM LANE | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284010000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103953477 | ||||||||
| FaxNumber: | 9108153479 | ||||||||
| Practice Location | |||||||||
| Address1: | 1124 GALLERY PARK BOULEVARD | ||||||||
| Address2: | #200 | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103413300 | ||||||||
| FaxNumber: | 9102512067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 01/17/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 105120 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 500022278 | 01 | NC | RAILROAD MEDICARE | OTHER |