Healthcare Provider Details

I. General information

NPI: 1508698986
Provider Name (Legal Business Name): ARYANNA MERCADO-SANTANA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 LIBERTY ST
SPRINGFIELD MA
01104-3736
US

IV. Provider business mailing address

40 AMHERST ST
GRANBY MA
01033-9442
US

V. Phone/Fax

Practice location:
  • Phone: 413-304-2925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN2387401
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: