Provider Demographics
NPI:1427029560
Name:SAEFKE-WOLC, LYNNETTE VIRGINIA (CRNA)
Entity Type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:VIRGINIA
Last Name:SAEFKE-WOLC
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4827 MANGET CT
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4807
Mailing Address - Country:US
Mailing Address - Phone:770-396-4704
Mailing Address - Fax:770-396-1576
Practice Address - Street 1:4827 MANGET CT
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4807
Practice Address - Country:US
Practice Address - Phone:770-396-4704
Practice Address - Fax:770-396-1576
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN059863367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300025744AMedicaid
GA300025744AMedicaid
FL43ZCBDZ20Medicare ID - Type Unspecified