Provider Demographics
NPI:1336870559
Name:DEANE, SAVANNAH JOY (FNP-C)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:JOY
Last Name:DEANE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-9707
Mailing Address - Country:US
Mailing Address - Phone:573-380-1466
Mailing Address - Fax:
Practice Address - Street 1:1212 SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2769
Practice Address - Country:US
Practice Address - Phone:573-614-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022022674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily