Provider Demographics
NPI:1407232028
Name:SIEVERS, SAVANNAH CARLY (PAC)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:CARLY
Last Name:SIEVERS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631
Mailing Address - Country:US
Mailing Address - Phone:970-810-5115
Mailing Address - Fax:970-810-3897
Practice Address - Street 1:1801 16TH ST
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631
Practice Address - Country:US
Practice Address - Phone:970-810-5115
Practice Address - Fax:970-810-3897
Is Sole Proprietor?:No
Enumeration Date:2015-08-05
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12675363A00000X
NC0010-05769363AM0700X
COPA.0006189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX398455102OtherMEDICAID-CSHCN
TX398455101Medicaid
TX8LB699OtherBCBS