Provider Demographics
NPI:1821758004
Name:HICKMAN, SAVANNAH RENEE
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RENEE
Last Name:HICKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HUGHART LN LOT 7
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-9384
Mailing Address - Country:US
Mailing Address - Phone:304-651-8944
Mailing Address - Fax:
Practice Address - Street 1:200 HUGHART LN LOT 7
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-9384
Practice Address - Country:US
Practice Address - Phone:304-651-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-29
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant