Healthcare Provider Details

I. General information

NPI: 1528380383
Provider Name (Legal Business Name): SHIFRA SAFER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 BONAVENTURE RD
THUNDERBOLT GA
31404-3299
US

IV. Provider business mailing address

3441 CYPRESS MILL RD SUITE 102
BRUNSWICK GA
31520-2878
US

V. Phone/Fax

Practice location:
  • Phone: 912-790-6527
  • Fax: 912-644-7729
Mailing address:
  • Phone: 912-554-8542
  • Fax: 912-264-5965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number199815
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: