Provider Demographics
NPI:1467265009
Name:DESANTIAGO, RACHEL ANN (CNA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:DESANTIAGO
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 W DODGE RD STE 201A
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3320
Mailing Address - Country:US
Mailing Address - Phone:402-393-0833
Mailing Address - Fax:
Practice Address - Street 1:15351 PAPIO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68138-3369
Practice Address - Country:US
Practice Address - Phone:402-201-8670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE76667374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty