Provider Demographics
NPI:1508165036
Name:SANTIAGO, NORA
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 NELSON AVE
Mailing Address - Street 2:APT. 5 F
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-3638
Mailing Address - Country:US
Mailing Address - Phone:646-542-5962
Mailing Address - Fax:
Practice Address - Street 1:1210 NELSON AVE
Practice Address - Street 2:APT. 5 F
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-3638
Practice Address - Country:US
Practice Address - Phone:646-542-5962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY242914164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse