Provider Demographics
NPI:1669612685
Name:SAVAGE, MAEGAN R (CNIM, LSA, CSFA, CST)
Entity type:Individual
Prefix:
First Name:MAEGAN
Middle Name:R
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:CNIM, LSA, CSFA, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14008 N 52ND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4813
Mailing Address - Country:US
Mailing Address - Phone:817-851-5517
Mailing Address - Fax:
Practice Address - Street 1:14008 N 52ND AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4813
Practice Address - Country:US
Practice Address - Phone:817-851-5517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113405171W00000X, 246ZS0410X
246ZC0007X
TX3853246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No171W00000XOther Service ProvidersContractor
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3853OtherABRET
TX113405OtherTHE NATIONAL BOARD OF SURGICAL TECHNOLOGY AND SURGICAL ASSISTING