Provider Demographics
NPI:1588245906
Name:CONGER, SAVANNA M (NP-C)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:M
Last Name:CONGER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SAVANNA
Other - Middle Name:M
Other - Last Name:ZICHELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BROTHERTON WAY
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-2684
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:165 CAMBRIDGE ST STE 501
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2759
Practice Address - Country:US
Practice Address - Phone:617-726-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-16
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2316609363L00000X
MAF04210283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily