Provider Demographics
NPI:1063512382
Name:SAFFORD, DEBRA ANNE
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANNE
Last Name:SAFFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BIRNAMWOOD
Mailing Address - State:WI
Mailing Address - Zip Code:54414-9262
Mailing Address - Country:US
Mailing Address - Phone:715-449-3268
Mailing Address - Fax:
Practice Address - Street 1:W12802 COUNTY ROAD A
Practice Address - Street 2:
Practice Address - City:BOWLER
Practice Address - State:WI
Practice Address - Zip Code:54416-9551
Practice Address - Country:US
Practice Address - Phone:715-793-4144
Practice Address - Fax:715-793-4120
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2939-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily