Provider Demographics
NPI:1396205043
Name:HERDER, SAVANNAH WREN (CRNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:WREN
Last Name:HERDER
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:WREN
Other - Last Name:MARETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:513 BROOKWOOD BLVD STE 275
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6806
Mailing Address - Country:US
Mailing Address - Phone:205-502-4700
Mailing Address - Fax:
Practice Address - Street 1:513 BROOKWOOD BLVD STE 275
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6806
Practice Address - Country:US
Practice Address - Phone:205-502-4700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156355163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse