Provider Demographics
NPI:1013097583
Name:SAVAGE, PENNIE DALTON (CRNP)
Entity type:Individual
Prefix:
First Name:PENNIE
Middle Name:DALTON
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3177
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21802-3177
Mailing Address - Country:US
Mailing Address - Phone:410-548-2343
Mailing Address - Fax:844-332-3891
Practice Address - Street 1:9715 HEALTHWAY DR
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-3500
Practice Address - Country:US
Practice Address - Phone:410-548-2343
Practice Address - Fax:844-332-3891
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR135131363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1013097583Medicaid
613653401OtherDEPT OF LABOR
145576ZBS6OtherMEDICARE
VA1013097583Medicaid