Provider Demographics
NPI:1386204741
Name:SAMANIE, SAVANNAH NUNLEY
Entity Type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:NUNLEY
Last Name:SAMANIE
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 1:311 ELM ST
Mailing Address - Street 2:
Mailing Address - City:LABADIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70372-2065
Mailing Address - Country:US
Mailing Address - Phone:985-413-1202
Mailing Address - Fax:
Practice Address - Street 1:315 TANGLEWOOD LN
Practice Address - Street 2:
Practice Address - City:BAY VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44140-1130
Practice Address - Country:US
Practice Address - Phone:440-668-5342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA18-57614106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician