Provider Demographics
NPI:1679659254
Name:SAVORY, MARYANN (FNP)
Entity Type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:SAVORY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-5279
Mailing Address - Country:US
Mailing Address - Phone:951-925-9565
Mailing Address - Fax:
Practice Address - Street 1:4020 W FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-5279
Practice Address - Country:US
Practice Address - Phone:951-925-9565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY2818363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30159ZOtherLINK TO BILLING ENTITY
CAQ22996Medicare UPIN
CAZZZ30255ZMedicare ID - Type Unspecified
CABH434ZMedicare PIN