Healthcare Provider Details

I. General information

NPI: 1679800411
Provider Name (Legal Business Name): MRS. KRISTINE D. SANTOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

9634 OAK SUMMIT AVE
PARKVILLE MD
21234-1824
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6704
  • Fax:
Mailing address:
  • Phone: 410-661-5635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR177946
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: