Provider Demographics
NPI:1457683609
Name:SANTIAGO, CINDY LOU (LPN)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:LOU
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 GOETTEL RD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:13036-2271
Mailing Address - Country:US
Mailing Address - Phone:315-676-2778
Mailing Address - Fax:
Practice Address - Street 1:121 GOETTEL RD
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036-2271
Practice Address - Country:US
Practice Address - Phone:315-676-2778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247637-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse