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NPI Code Detail

MEDICARE: SAVANNAH PONTIFF

MEDICARE: SAVANNAH PONTIFF
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
1363L00000XNurse Practitioner237588LA

General Provider Information

NPI Number : 1396568812
Entity Type Code : Individual
Provider Name (Legal Business Name) : SAVANNAH PONTIFF
Provider Business Mailing Address
First Line : 128 NEUROSCIENCE CT
Second Line :
City : GRAY
State : LA
Zip : 70359-5209
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 128 NEUROSCIENCE CT
Second Line :
City : GRAY
State : LA
Zip : 70359-5209
Country : US
Telephone Number : 985-917-3007
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/04/2024
Last Update Date : 11/04/2024

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Directions to “ SAVANNAH PONTIFF ” Practice Location

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