Provider Demographics
NPI:1659262038
Name:WILSON, SAVANAH (MSN, RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:SAVANAH
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22301 GENESIS DR
Mailing Address - Street 2:
Mailing Address - City:WOODHAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-5263
Mailing Address - Country:US
Mailing Address - Phone:734-552-5754
Mailing Address - Fax:
Practice Address - Street 1:22301 GENESIS DR
Practice Address - Street 2:
Practice Address - City:WOODHAVEN
Practice Address - State:MI
Practice Address - Zip Code:48183-5263
Practice Address - Country:US
Practice Address - Phone:734-552-5754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704370958363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics