Provider Demographics
NPI:1013528561
Name:WHITE, SAVONNA RAE (LPN)
Entity Type:Individual
Prefix:
First Name:SAVONNA
Middle Name:RAE
Last Name:WHITE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PERINTON ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-3117
Mailing Address - Country:US
Mailing Address - Phone:585-752-5016
Mailing Address - Fax:
Practice Address - Street 1:15 PERINTON ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-3117
Practice Address - Country:US
Practice Address - Phone:585-752-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338188164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse