Provider Demographics
NPI:1245802388
Name:SAFFERSON, SALLY GOLDEN (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:GOLDEN
Last Name:SAFFERSON
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 GRAND OAKS CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22181-5438
Mailing Address - Country:US
Mailing Address - Phone:703-244-4329
Mailing Address - Fax:
Practice Address - Street 1:500 N WASHINGTON ST STE 300
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3514
Practice Address - Country:US
Practice Address - Phone:571-419-5640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182181363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health