Provider Demographics
NPI:1952453458
Name:SAVAGE, JEFFREY W (CRNA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:SAVAGE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 NC HIGHWAY 11
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:NC
Mailing Address - Zip Code:28478-6928
Mailing Address - Country:US
Mailing Address - Phone:910-642-8011
Mailing Address - Fax:910-642-9328
Practice Address - Street 1:500 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WHITEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28472-3634
Practice Address - Country:US
Practice Address - Phone:910-642-8011
Practice Address - Fax:910-642-9328
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC051768367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051927Medicaid
NC8051927Medicaid