Provider Demographics
NPI:1518779842
Name:STILTNER, SAVANNAH NICOLE
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:NICOLE
Last Name:STILTNER
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 19
Mailing Address - Street 2:
Mailing Address - City:MAXIE
Mailing Address - State:VA
Mailing Address - Zip Code:24628-0019
Mailing Address - Country:US
Mailing Address - Phone:276-701-6861
Mailing Address - Fax:
Practice Address - Street 1:18765 RIVERSIDE DR, VANSANT, VA 24656
Practice Address - Street 2:
Practice Address - City:VANSANT
Practice Address - State:VA
Practice Address - Zip Code:24656
Practice Address - Country:US
Practice Address - Phone:276-935-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001302989163W00000X
VA0024192630363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse