Provider Demographics
NPI:1265899900
Name:ERTEL, SAVANNAH RAE (PA-C)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:RAE
Last Name:ERTEL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:RAE
Other - Last Name:KLINGSHIRN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:770 KAPIOLANI BLVD STE 705
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-5241
Mailing Address - Country:US
Mailing Address - Phone:808-597-8778
Mailing Address - Fax:
Practice Address - Street 1:1301 PUNCHBOWL ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813
Practice Address - Country:US
Practice Address - Phone:808-691-4311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-26
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004450363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI3740-23OtherWISCONSIN MEDICAL BOARD
HIAMD812OtherHAWAII MEDICAL BOARD