Healthcare Provider Details

I. General information

NPI: 1457584179
Provider Name (Legal Business Name): DORIS SANTIAGO MSN,R.N,A.P.N.,C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

248 DEMOTT AVE
CLIFTON NJ
07011-3737
US

IV. Provider business mailing address

248 DEMOTT AVE
CLIFTON NJ
07011-3737
US

V. Phone/Fax

Practice location:
  • Phone: 973-563-4396
  • Fax: 973-744-6160
Mailing address:
  • Phone: 973-563-4396
  • Fax: 973-744-6160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number26NJ00232900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: