1700939006 NPI number — LANA KAY SAFFERT M.A.

Table of content: LANA KAY SAFFERT M.A. (NPI 1700939006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700939006 NPI number — LANA KAY SAFFERT M.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFFERT
Provider First Name:
LANA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700939006
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7373 147TH ST W
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55124-7690
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-432-3220
Provider Business Mailing Address Fax Number:
952-891-4622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7373 147TH ST W
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
APPLE VALLEY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55124-7690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-432-3220
Provider Business Practice Location Address Fax Number:
952-891-4622
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP3323 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 269K3SA . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 62-69227 . This is a "UBH" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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