Healthcare Provider Details

I. General information

NPI: 1336934686
Provider Name (Legal Business Name): SAVANNAH PLATH ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8382 N WAYNE DR STE 204
HAYDEN ID
83835-6028
US

IV. Provider business mailing address

8382 N WAYNE DR STE 204
HAYDEN ID
83835-6028
US

V. Phone/Fax

Practice location:
  • Phone: 208-635-5265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4071858
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61667018
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: