Individual
SAVANNAH A CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
Mailing address
100 HOSPITAL DR, LEBANON, MO 65536-9210
(417) 533-6100
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
2013026436
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992147615
—
MO
05
—
199441001
—
AR
01
—
431560263
TRICARE
MO
01
—
P01235238
RR MCR
MO
Enumeration date
07/23/2013
Last updated
04/23/2021
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