Provider Demographics
NPI:1477020550
Name:SANTOS, MIRIAM (RN)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 LOGAN AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2311
Mailing Address - Country:US
Mailing Address - Phone:347-963-2368
Mailing Address - Fax:
Practice Address - Street 1:827 LOGAN AVE FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2311
Practice Address - Country:US
Practice Address - Phone:347-963-2368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY435716163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse