Provider Demographics
NPI:1497395040
Name:DOLENGO SANTIAGO, LORRAINE (RN)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:DOLENGO SANTIAGO
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 1:2756 TENBROECK AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5325
Mailing Address - Country:US
Mailing Address - Phone:718-882-2118
Mailing Address - Fax:
Practice Address - Street 1:2756 TENBROECK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5325
Practice Address - Country:US
Practice Address - Phone:718-882-2118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY605662163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse