Provider Demographics
NPI:1720776008
Name:MCGRATH, SAVANNAH MARIE (RD)
Entity Type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MARIE
Last Name:MCGRATH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:MARIE
Other - Last Name:PAVLAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:490 DEER LAKE RD
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9767
Mailing Address - Country:US
Mailing Address - Phone:906-440-6366
Mailing Address - Fax:
Practice Address - Street 1:490 DEER LAKE RD
Practice Address - Street 2:
Practice Address - City:ISHPEMING
Practice Address - State:MI
Practice Address - Zip Code:49849-9767
Practice Address - Country:US
Practice Address - Phone:906-440-6366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86017492133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered