Provider Demographics
NPI:1477329506
Name:BOLIN, SAVANNA PAIGE (PA)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:PAIGE
Last Name:BOLIN
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 1:1307 E HENRY CLAY AVE
Mailing Address - Street 2:
Mailing Address - City:FT WRIGHT
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3721
Mailing Address - Country:US
Mailing Address - Phone:859-547-2099
Mailing Address - Fax:
Practice Address - Street 1:85 CAROTHERS RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2415
Practice Address - Country:US
Practice Address - Phone:859-261-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant