Healthcare Provider Details

I. General information

NPI: 1174684179
Provider Name (Legal Business Name): YVONNE SANTIAGO RN PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 MIDWAY PARK DRIVE ORANGE PEDIATRIC ASSOCIATES PC
MIDDLETOWN NY
10940
US

IV. Provider business mailing address

400 MIDWAY PARK DRIVE
MIDDLETOWN NY
10940
US

V. Phone/Fax

Practice location:
  • Phone: 845-343-0728
  • Fax: 845-343-2087
Mailing address:
  • Phone: 845-343-0728
  • Fax: 845-343-2087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number237327
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberF3801311
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: