Healthcare Provider Details

I. General information

NPI: 1013497312
Provider Name (Legal Business Name): ELIZABETH HAYES SANTIAGO NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2018
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2102 STANTONSBURG RD
GREENVILLE NC
27834-2783
US

IV. Provider business mailing address

PO BOX 275
WINTERVILLE NC
28590-0275
US

V. Phone/Fax

Practice location:
  • Phone: 252-847-4378
  • Fax:
Mailing address:
  • Phone: 484-274-1421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number5010861
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: