Provider Demographics
NPI:1518457282
Name:SANTOS, RITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:RITA LEILA MENDONCA
Other - Middle Name:DIONISIO DE PAULA
Other - Last Name:SANTOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:5132 N ELSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2429
Mailing Address - Country:US
Mailing Address - Phone:847-235-6130
Mailing Address - Fax:847-941-0577
Practice Address - Street 1:20531 DARDEN RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46637-2915
Practice Address - Country:US
Practice Address - Phone:574-272-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009009A363L00000X
MI4704273192363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner