Provider Demographics
NPI:1295467769
Name:BOSS, SAVANAH JUNE MARGARET
Entity Type:Individual
Prefix:
First Name:SAVANAH
Middle Name:JUNE MARGARET
Last Name:BOSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14540 E KAMM AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-9202
Mailing Address - Country:US
Mailing Address - Phone:559-269-7337
Mailing Address - Fax:
Practice Address - Street 1:14540 E KAMM AVE
Practice Address - Street 2:
Practice Address - City:KINGSBURG
Practice Address - State:CA
Practice Address - Zip Code:93631-9202
Practice Address - Country:US
Practice Address - Phone:559-269-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-24
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95193956163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse