Provider Demographics
NPI:1639809486
Name:SNELL, SAVANNAH ELISE (PA)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:ELISE
Last Name:SNELL
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 1:2700 E 30TH AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1242
Mailing Address - Country:US
Mailing Address - Phone:620-663-8484
Mailing Address - Fax:620-663-9526
Practice Address - Street 1:2700 E 30TH AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1242
Practice Address - Country:US
Practice Address - Phone:620-663-8484
Practice Address - Fax:620-663-9526
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
KS15-02685363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program