Healthcare Provider Details

I. General information

NPI: 1477934859
Provider Name (Legal Business Name): BEVERLY A SANTANA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 06/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BANNING ST STE 320
DOVER DE
19904-3488
US

IV. Provider business mailing address

200 BANNING ST STE 320
DOVER DE
19904-3488
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-0223
  • Fax:
Mailing address:
  • Phone: 302-674-0223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberLK-0000178
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: