Provider Demographics
NPI:1790235141
Name:SANTIAGO, MARIA VANEEZA (CRNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VANEEZA
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:VANEEZA
Other - Last Name:CASTAGUETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 DOCK HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17842-8910
Mailing Address - Country:US
Mailing Address - Phone:570-837-2123
Mailing Address - Fax:570-837-2185
Practice Address - Street 1:2850 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-9383
Practice Address - Country:US
Practice Address - Phone:717-657-1361
Practice Address - Fax:717-657-5396
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN556914163W00000X
PASP016665363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031963710001Medicaid
PA540189F6KOtherMEDICARE