MEDICARE: SAVANNAH ROSE WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1093661795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAVANNAH ROSE WELLNESS

Provider Business Mailing Address
First Line	:	1121 SWEETSHRUB CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-7600
Country	:	US
Telephone Number	:	910-232-0140
Fax Number	:

Provider Business Practice Location Address
First Line	:	1121 SWEETSHRUB CT
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28409-7600
Country	:	US
Telephone Number	:	910-232-0140
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	DR. HEATHER BLACK
Credential	:	DNP, PMHNP
Telephone Number	:	910-232-0140

Provider Enumeration Date	:	03/06/2026
Last Update Date	:	03/06/2026

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