Provider Demographics
NPI:1811582091
Name:DETTREY, SAVANHA
Entity Type:Individual
Prefix:
First Name:SAVANHA
Middle Name:
Last Name:DETTREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANHA
Other - Middle Name:
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5993 MCKENDREE RD
Mailing Address - Street 2:
Mailing Address - City:THURMOND
Mailing Address - State:WV
Mailing Address - Zip Code:25936-8007
Mailing Address - Country:US
Mailing Address - Phone:304-719-6281
Mailing Address - Fax:304-471-2488
Practice Address - Street 1:1799 MAIN ST E
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901-2341
Practice Address - Country:US
Practice Address - Phone:304-465-0885
Practice Address - Fax:304-465-0886
Is Sole Proprietor?:No
Enumeration Date:2021-03-09
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker