Provider Demographics
NPI:1093308108
Name:SAFIRAN, MARY L
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:SAFIRAN
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 1:5539 S QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-5157
Mailing Address - Country:US
Mailing Address - Phone:630-393-1976
Mailing Address - Fax:
Practice Address - Street 1:5539 S QUINCY ST
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-5157
Practice Address - Country:US
Practice Address - Phone:630-393-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041341966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse