Healthcare Provider Details

I. General information

NPI: 1144153628
Provider Name (Legal Business Name): SAVANNAH ROSENE WIDMAIER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK
WHEELING WV
26003-6379
US

IV. Provider business mailing address

259 GRANT ST
IRWIN PA
15642-2561
US

V. Phone/Fax

Practice location:
  • Phone: 304-243-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: