Provider Demographics
NPI:1235296013
Name:SAFFO, EDITH LYNNE (NP)
Entity type:Individual
Prefix:
First Name:EDITH
Middle Name:LYNNE
Last Name:SAFFO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2421 SILVER STREAM LANE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-0000
Mailing Address - Country:US
Mailing Address - Phone:910-395-3477
Mailing Address - Fax:910-815-3479
Practice Address - Street 1:1124 GALLERY PARK BOULEVARD
Practice Address - Street 2:#200
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412
Practice Address - Country:US
Practice Address - Phone:910-341-3300
Practice Address - Fax:910-251-2067
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105120363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC500022278OtherRAILROAD MEDICARE
NC2804972Medicare PIN
NC2804972AMedicare PIN
NC500022278OtherRAILROAD MEDICARE
NC2804972BMedicare PIN