Provider Demographics
NPI:1730543158
Name:HAREBOTTLE, SAVANNAH EOM (APRN)
Entity type:Individual
Prefix:MS
First Name:SAVANNAH
Middle Name:EOM
Last Name:HAREBOTTLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:YOUKYOUNG
Other - Middle Name:
Other - Last Name:EOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:130 HAYS ST
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:TX
Mailing Address - Zip Code:78648-3207
Mailing Address - Country:US
Mailing Address - Phone:830-875-7000
Mailing Address - Fax:
Practice Address - Street 1:2010 HOFFMANN LN
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-4106
Practice Address - Country:US
Practice Address - Phone:512-785-9789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130220363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner