Provider Demographics
NPI:1053169144
Name:MUISE, SAVANNAH MARIE
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MARIE
Last Name:MUISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:179 N 700 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2650
Mailing Address - Country:US
Mailing Address - Phone:403-915-3975
Mailing Address - Fax:
Practice Address - Street 1:1800 NOVELL PL
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-6171
Practice Address - Country:US
Practice Address - Phone:801-375-5125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program