Provider Demographics
NPI:1679982458
Name:DESANTIS, ILONA ANNA (CNM)
Entity Type:Individual
Prefix:MRS
First Name:ILONA
Middle Name:ANNA
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:CNM
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Mailing Address - Street 1:34 EDWARD DR
Mailing Address - Street 2:
Mailing Address - City:RINGWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07456-2709
Mailing Address - Country:US
Mailing Address - Phone:973-962-0874
Mailing Address - Fax:973-998-7925
Practice Address - Street 1:25 LINDSLEY DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-4455
Practice Address - Country:US
Practice Address - Phone:973-998-7922
Practice Address - Fax:973-998-7925
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-06
Last Update Date:2014-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25ME00056101367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife