Basic Information
| Provider Information | |||||||||
| NPI: | 1457434946 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAFO | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2168 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581072168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012342119 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2400 32ND AVE S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581035800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7012348830 | ||||||||
| FaxNumber: | 7012348950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2006 | ||||||||
| LastUpdateDate: | 02/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 47767 | MN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | HP54864 | 01 | MN | HEALTHPARTNERS/URGENT CAR | OTHER | 006686900 | 05 | MN | MEDICAID | 81276 | 05 | ND | MEDICAID | 106789 | 01 | MN | UCARE/URGENT CARE | OTHER | 399G9SA | 01 | MN | BCBS | OTHER | 66-08641 | 01 | MN | MEDICA/URGENT CARE | OTHER | 1032683 | 01 | MN | PREFERRED ONE/URGENT CARE | OTHER | 43523300 | 05 | WI | MEDICAID | 0596262 | 05 | IA | MEDICAID |