1730543158 NPI number — MS. SAVANNAH EOM HAREBOTTLE APRN

Table of content: MS. SAVANNAH EOM HAREBOTTLE APRN (NPI 1730543158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730543158 NPI number — MS. SAVANNAH EOM HAREBOTTLE APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAREBOTTLE
Provider First Name:
SAVANNAH
Provider Middle Name:
EOM
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EOM
Provider Other First Name:
YOUKYOUNG
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730543158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 HAYS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LULING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78648-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-875-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2010 HOFFMANN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78132-4106
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-785-9789
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/12/2016

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: 363L00000X , with the licence number:  AP130220 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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