| NPI | 1952135576 |
|---|---|
| Former Name | SAVANNA JAYE STALEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: IL 085.010776) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2024-08-27 |
| Last Update Date | 2025-04-22 |