Provider Demographics
NPI:1396062345
Name:CORPUS-SANTIAGO, RACHELLE LAO (RN)
Entity type:Individual
Prefix:
First Name:RACHELLE
Middle Name:LAO
Last Name:CORPUS-SANTIAGO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S CENTRAL AVE
Mailing Address - Street 2:APT B58
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3146
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 S CENTRAL AVE
Practice Address - Street 2:APT B58
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3146
Practice Address - Country:US
Practice Address - Phone:914-356-6438
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-30
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY596383-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse