Provider Demographics
NPI:1154055317
Name:BARTZ, SAVANAH MARIE (LPN)
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:MARIE
Last Name:BARTZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SAVANAH
Other - Middle Name:
Other - Last Name:STOFIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14709 GLEN OAK RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-9073
Mailing Address - Country:US
Mailing Address - Phone:971-219-7101
Mailing Address - Fax:
Practice Address - Street 1:3550 N INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1196
Practice Address - Country:US
Practice Address - Phone:503-331-5172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201230088LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse