MEDICARE: SAVANNA JAYE SNOW PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363AM0700X	Medical Physician Assistant	085.010776	IL

General Provider Information

NPI Number	:	1952135576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAVANNA JAYE SNOW PA-C

Provider Business Mailing Address
First Line	:	23799 SPRING CREEK RD
Second Line	:
City	:	WASHINGTON
State	:	IL
Zip	:	61571-9667
Country	:	US
Telephone Number	:	618-218-8241
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61603-3106
Country	:	US
Telephone Number	:	618-218-8241
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2024
Last Update Date	:	04/22/2025

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