Provider Demographics
NPI:1639175284
Name:SANTOS, JULIET ALFONSO (MSN, APRN, BC)
Entity Type:Individual
Prefix:MISS
First Name:JULIET
Middle Name:ALFONSO
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16106 ASPEN HOLW
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9138
Mailing Address - Country:US
Mailing Address - Phone:810-750-8365
Mailing Address - Fax:810-750-8365
Practice Address - Street 1:9340 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-3362
Practice Address - Country:US
Practice Address - Phone:313-295-3388
Practice Address - Fax:313-295-4198
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704165746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMA0610712OtherDEA
MION51610002Medicare ID - Type Unspecified