Provider Demographics
NPI:1497815641
Name:SANTIAGO, JO A (LPN)
Entity Type:Individual
Prefix:
First Name:JO
Middle Name:A
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 1:1233 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-5445
Mailing Address - Country:US
Mailing Address - Phone:203-645-1532
Mailing Address - Fax:
Practice Address - Street 1:1233 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-5445
Practice Address - Country:US
Practice Address - Phone:203-645-1532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135537-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse