Provider Demographics
NPI:1356153431
Name:BLACKWELL, SAVANNA
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:BLACKWELL
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:PO BOX 1624
Mailing Address - Street 2:
Mailing Address - City:OVERTON
Mailing Address - State:NV
Mailing Address - Zip Code:89040-1624
Mailing Address - Country:US
Mailing Address - Phone:928-234-7678
Mailing Address - Fax:
Practice Address - Street 1:2400 ST JOSEPH ST
Practice Address - Street 2:
Practice Address - City:LOGANDALE
Practice Address - State:NV
Practice Address - Zip Code:89021
Practice Address - Country:US
Practice Address - Phone:702-397-2611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer