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NPI Code Detail

MEDICARE: FNU SAFA

MEDICARE: FNU SAFA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1548104441
Entity Type Code : Individual
Provider Name (Legal Business Name) : FNU SAFA
Provider Business Mailing Address
First Line : 5970 CHURCHVIEW DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2574
Country : US
Telephone Number : 815-971-8990
Fax Number : 815-971-9978
Provider Business Practice Location Address
First Line : 5970 CHURCHVIEW DR
Second Line :
City : ROCKFORD
State : IL
Zip : 61107-2574
Country : US
Telephone Number : 815-971-8990
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2026
Last Update Date : 04/20/2026

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Directions to “ FNU SAFA ” Practice Location

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