Provider Demographics
NPI:1821563222
Name:STUCKI, SAVANNAH MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MARIE
Last Name:STUCKI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:SCHOOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:131 S DEARBORN ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-5517
Mailing Address - Country:US
Mailing Address - Phone:917-261-4414
Mailing Address - Fax:
Practice Address - Street 1:131 S DEARBORN ST STE 1025
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-5517
Practice Address - Country:US
Practice Address - Phone:917-261-4414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17266363A00000X
NY029477363A00000X
IL085008118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant