Provider Demographics
NPI:1649592049
Name:SAVAGE, SHIRLEY L (LPN)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:L
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 BROADWAY AVE.
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MENANDS
Mailing Address - State:NY
Mailing Address - Zip Code:12204
Mailing Address - Country:US
Mailing Address - Phone:518-694-9904
Mailing Address - Fax:518-694-9914
Practice Address - Street 1:150 BROADWAY AVE.
Practice Address - Street 2:SUITE 310
Practice Address - City:MENANDS
Practice Address - State:NY
Practice Address - Zip Code:12204
Practice Address - Country:US
Practice Address - Phone:518-694-9904
Practice Address - Fax:518-694-9914
Is Sole Proprietor?:No
Enumeration Date:2010-02-26
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267395-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse