Provider Demographics
NPI:1043588148
Name:SANTIAGO, RASIA MYKONO (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RASIA
Middle Name:MYKONO
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-1547
Mailing Address - Country:US
Mailing Address - Phone:541-232-8900
Mailing Address - Fax:
Practice Address - Street 1:151 W 7TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1100
Practice Address - Country:US
Practice Address - Phone:541-682-3550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201030371LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201030371LPNOtherLPN LICENSURE