Provider Demographics
NPI:1861043770
Name:LATIMER, SAVANNA (RD, LDN)
Entity Type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:LATIMER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 W WILDERNESS WAY APT 299
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-6848
Mailing Address - Country:US
Mailing Address - Phone:225-223-4116
Mailing Address - Fax:
Practice Address - Street 1:9000 W WILDERNESS WAY APT 299
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-6848
Practice Address - Country:US
Practice Address - Phone:224-223-4116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2842133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered