Provider Demographics
NPI:1326608951
Name:STROM, SAVANNAH (PA)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:STROM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:
Mailing Address - City:HERFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27924
Mailing Address - Country:US
Mailing Address - Phone:252-426-5711
Mailing Address - Fax:252-426-1911
Practice Address - Street 1:306 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28697-2854
Practice Address - Country:US
Practice Address - Phone:336-651-7533
Practice Address - Fax:336-651-7813
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-09170363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001009170OtherNORTH CAROLINA MEDICAL BOARD