Provider Demographics
NPI:1982143335
Name:CANTU SANTOLI, SHANNAN (CNM)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:
Last Name:CANTU SANTOLI
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 SOUTH LAKE DR.
Mailing Address - Street 2:
Mailing Address - City:CUDAHY
Mailing Address - State:WI
Mailing Address - Zip Code:53110-6108
Mailing Address - Country:US
Mailing Address - Phone:618-997-5266
Mailing Address - Fax:618-997-5285
Practice Address - Street 1:5050 SOUTH LAKE DR.
Practice Address - Street 2:#100510
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-6108
Practice Address - Country:US
Practice Address - Phone:414-769-2239
Practice Address - Fax:618-997-5285
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015629367A00000X
WI148990-32176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1982143335Medicaid
WI1000-947-56Medicaid