Provider Demographics
NPI:1811723117
Name:BANNER, SAVANNA ROSE (LPN)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:ROSE
Last Name:BANNER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:SAVANNA
Other - Middle Name:ROSE
Other - Last Name:ZYCHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:506 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-5136
Mailing Address - Country:US
Mailing Address - Phone:330-888-0999
Mailing Address - Fax:
Practice Address - Street 1:506 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-5136
Practice Address - Country:US
Practice Address - Phone:330-888-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 347C00000X, 372600000X, 376J00000X, 385HR2060X, 385HR2065X
OH160726164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No347C00000XTransportation ServicesPrivate Vehicle
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child