Basic Information
Provider Information
NPI: 1033775945
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SAFFAR
FirstName: VALERIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: APRN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 12251 S 80TH AVE
Address2:  
City: PALOS HEIGHTS
State: IL
PostalCode: 604631290
CountryCode: US
TelephoneNumber: 7089235869
FaxNumber: 7089235859
Practice Location
Address1: 12251 S 80TH AVE
Address2:  
City: PALOS HEIGHTS
State: IL
PostalCode: 604631290
CountryCode: US
TelephoneNumber: 7089235869
FaxNumber: 7089235859
Other Information
ProviderEnumerationDate: 05/15/2019
LastUpdateDate: 12/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X209.018678ILN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363L00000X209018678ILY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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