Provider Demographics
NPI:1346969870
Name:LARSEN, SAVANNAH MARGUERITE (CRNA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:MARGUERITE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 738382
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-8382
Mailing Address - Country:US
Mailing Address - Phone:719-584-4045
Mailing Address - Fax:719-542-0809
Practice Address - Street 1:58 CLUB MANOR DR
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1601
Practice Address - Country:US
Practice Address - Phone:719-584-4054
Practice Address - Fax:719-542-0809
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI236529-30163W00000X
COAPN.0999819-CRNA367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse