Healthcare Provider Details

I. General information

NPI: 1912579152
Provider Name (Legal Business Name): SAVANNAH MARIA GUZMAN ELLIOTT RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 07/16/2021
Certification Date: 07/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4115 AMBASSADOR DR
ANCHORAGE AK
99508
US

IV. Provider business mailing address

4115 AMBASSADOR DR
ANCHORAGE AK
99508
US

V. Phone/Fax

Practice location:
  • Phone: 907-729-3639
  • Fax:
Mailing address:
  • Phone: 907-729-3639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: