Provider Demographics
NPI:1063235372
Name:BALTRUSCH, SAVANNAH
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:BALTRUSCH
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 1:9225 66TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:BOWBELLS
Mailing Address - State:ND
Mailing Address - Zip Code:58721-9328
Mailing Address - Country:US
Mailing Address - Phone:307-689-1735
Mailing Address - Fax:
Practice Address - Street 1:9225 66TH AVE NW
Practice Address - Street 2:
Practice Address - City:BOWBELLS
Practice Address - State:ND
Practice Address - Zip Code:58721-9328
Practice Address - Country:US
Practice Address - Phone:307-689-1735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDBAL866497172A00000X
372500000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172A00000XOther Service ProvidersDriver
No372500000XNursing Service Related ProvidersChore Provider