Provider Demographics
NPI:1265201230
Name:ROSAMOND, SAVANNAH MAENSIVU
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MAENSIVU
Last Name:ROSAMOND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 AVON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-4016
Mailing Address - Country:US
Mailing Address - Phone:407-810-0817
Mailing Address - Fax:
Practice Address - Street 1:3607 AVON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-4016
Practice Address - Country:US
Practice Address - Phone:407-810-0817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR226826163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice