Provider Demographics
NPI:1689130460
Name:SANTOS, MARCIO F (RN)
Entity Type:Individual
Prefix:
First Name:MARCIO
Middle Name:F
Last Name:SANTOS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 ABERG AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4202
Mailing Address - Country:US
Mailing Address - Phone:608-515-6817
Mailing Address - Fax:
Practice Address - Street 1:1818 ABERG AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-4202
Practice Address - Country:US
Practice Address - Phone:608-515-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI224304-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse