Provider Demographics
NPI:1922599620
Name:MONETTE, SAVANNAH SKYY (MS, LAT, ATC, NR-EMT)
Entity Type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:SKYY
Last Name:MONETTE
Suffix:
Gender:F
Credentials:MS, LAT, ATC, NR-EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-2575
Mailing Address - Country:US
Mailing Address - Phone:734-751-0617
Mailing Address - Fax:
Practice Address - Street 1:110 S MADISON ST
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-2575
Practice Address - Country:US
Practice Address - Phone:734-751-0617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2004863146N00000X
MI26010022402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic