Healthcare Provider Details

I. General information

NPI: 1588905046
Provider Name (Legal Business Name): MARY ANN SANTOS APRN CNP NEONATAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE
BOSTON MA
02115-5724
US

IV. Provider business mailing address

101 DUDLEY ST MSO
PROVIDENCE RI
02905-2401
US

V. Phone/Fax

Practice location:
  • Phone: 617-335-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN00327
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberCNP2272052
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: