Healthcare Provider Details

I. General information

NPI: 1801711809
Provider Name (Legal Business Name): SAVANNAH SKYE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4965 E LOST BRIDGE RD
DECATUR IL
62521-5139
US

IV. Provider business mailing address

4965 E LOST BRIDGE RD
DECATUR IL
62521-5139
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-5531
  • Fax: 217-864-2449
Mailing address:
  • Phone: 217-864-5531
  • Fax: 217-864-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041504437
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: