Provider Demographics
NPI:1043087034
Name:MORY, SAVANNAH FAITH (PA)
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:FAITH
Last Name:MORY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2842 N MELPOMENE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85749-9768
Mailing Address - Country:US
Mailing Address - Phone:520-304-8270
Mailing Address - Fax:
Practice Address - Street 1:2842 N MELPOMENE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-9768
Practice Address - Country:US
Practice Address - Phone:520-304-8270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-08
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10733363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant