Healthcare Provider Details

I. General information

NPI: 1811519085
Provider Name (Legal Business Name): SAVANNAH ALDER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SAVANNAH SKABELUND

II. Dates (important events)

Enumeration Date: 05/11/2020
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 N 1250 E
LOGAN UT
84321-4920
US

IV. Provider business mailing address

82 N 1250 E
LOGAN UT
84321-4920
US

V. Phone/Fax

Practice location:
  • Phone: 435-770-1680
  • Fax:
Mailing address:
  • Phone: 435-770-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9410623-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: