Provider Demographics
NPI:1396205043
Name:HERDER, SAVANNAH WREN (CRNP, FNP-C)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:WREN
Last Name:HERDER
Suffix:
Gender:F
Credentials:CRNP, FNP-C
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:WREN
Other - Last Name:MARETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:256-705-4224
Mailing Address - Fax:
Practice Address - Street 1:3601 CCI DR NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35805-2606
Practice Address - Country:US
Practice Address - Phone:256-705-4224
Practice Address - Fax:256-705-4135
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-156355363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily