Provider Demographics
NPI:1003609769
Name:PETTENATI, SAVANNAH
Entity type:Individual
Prefix:
First Name:SAVANNAH
Middle Name:
Last Name:PETTENATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAVANNAH
Other - Middle Name:
Other - Last Name:BROUSSEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:74 BENOIT ST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-4501
Mailing Address - Country:US
Mailing Address - Phone:774-218-0032
Mailing Address - Fax:
Practice Address - Street 1:1700A PRESIDENT AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-7148
Practice Address - Country:US
Practice Address - Phone:774-328-2144
Practice Address - Fax:774-241-7378
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRN43701163W00000X
MARN270477163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse