Provider Demographics
NPI:1477333128
Name:EAVES, SAVANNA DAWN (ACNPC-AG)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:DAWN
Last Name:EAVES
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8455 FERN AVE APT 1008
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5781
Mailing Address - Country:US
Mailing Address - Phone:318-315-0557
Mailing Address - Fax:
Practice Address - Street 1:8720 QUIMPER PL STE 100
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5742
Practice Address - Country:US
Practice Address - Phone:318-222-5711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA231116363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care