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General NPI Number Information
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NPI Number | 1356153431
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Entity Type | Individual
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Provider Name | SAVANNA BLACKWELL
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Gender | Female
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Dates
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Enumeration Date | 01/24/2025
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2400 ST JOSEPH ST
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City | LOGANDALE
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State | NV
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Zip | 89021
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Country | US
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Telephone | 702-397-2611
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1624
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City | OVERTON
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State | NV
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Zip | 89040-1624
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Country | US
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Telephone | 928-234-7678
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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