Healthcare Provider Details

I. General information

NPI: 1801723580
Provider Name (Legal Business Name): SAVANNAH LEE CNA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 S NEEDLES HWY
LAUGHLIN NV
89029-0814
US

IV. Provider business mailing address

450 S 900 E STE 100
SALT LAKE CITY UT
84102-2983
US

V. Phone/Fax

Practice location:
  • Phone: 702-703-1262
  • Fax:
Mailing address:
  • Phone: 385-252-3010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number900532
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: