Provider Demographics
NPI:1275553562
Name:SANTOS, DEBRA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:SANTOS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:282 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-2454
Mailing Address - Country:US
Mailing Address - Phone:203-453-0209
Mailing Address - Fax:203-643-8040
Practice Address - Street 1:282 DURHAM RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2454
Practice Address - Country:US
Practice Address - Phone:203-453-0209
Practice Address - Fax:203-643-8040
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001934364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health