1457553257 NPI number — MRS. PATRICIA ANN SAVAGE CPNP

Table of content: MRS. PATRICIA ANN SAVAGE CPNP (NPI 1457553257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457553257 NPI number — MRS. PATRICIA ANN SAVAGE CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAVAGE
Provider First Name:
PATRICIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457553257
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 609
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLD BEACH
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97444-0609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-247-0897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94235 MOORE ST
Provider Second Line Business Practice Location Address:
SUITE 121
Provider Business Practice Location Address City Name:
GOLD BEACH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97444-9699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-247-3300
Provider Business Practice Location Address Fax Number:
541-247-5601
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  000032995N2 PNP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R105279 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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