Provider Demographics
NPI:1003605585
Name:ELLIS, SAVANNAH D (LPN)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:D
Last Name:ELLIS
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 W MELCHOIR DR S
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-6148
Mailing Address - Country:US
Mailing Address - Phone:930-259-0246
Mailing Address - Fax:
Practice Address - Street 1:1510 W FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1032
Practice Address - Country:US
Practice Address - Phone:812-602-0176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-02
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27076830A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse