Provider Demographics
NPI:1053169144
Name:MUISE, SAVANNAH MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:SAVANNAH
Middle Name:MARIE
Last Name:MUISE
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 1:179 N 700 W
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84601-2650
Mailing Address - Country:US
Mailing Address - Phone:403-915-3975
Mailing Address - Fax:
Practice Address - Street 1:15 ALTARINDA RD STE 100
Practice Address - Street 2:
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2607
Practice Address - Country:US
Practice Address - Phone:925-253-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA66994363AM0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program