Provider Demographics
NPI:1063866804
Name:DOS SANTOS, CATHERINE E (MSN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:E
Last Name:DOS SANTOS
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3421 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46517-3125
Mailing Address - Country:US
Mailing Address - Phone:574-295-7178
Mailing Address - Fax:574-295-8822
Practice Address - Street 1:3421 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3125
Practice Address - Country:US
Practice Address - Phone:574-295-7178
Practice Address - Fax:574-295-8822
Is Sole Proprietor?:No
Enumeration Date:2016-04-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006286A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201363480Medicaid