Provider Demographics
NPI:1952135576
Name:SNOW, SAVANNA JAYE (PA-C)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:JAYE
Last Name:SNOW
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANNA
Other - Middle Name:JAYE
Other - Last Name:STALEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23799 SPRING CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9667
Mailing Address - Country:US
Mailing Address - Phone:618-218-8241
Mailing Address - Fax:
Practice Address - Street 1:420 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61603-3106
Practice Address - Country:US
Practice Address - Phone:618-218-8241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
IL085.010776363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant