Healthcare Provider Details

I. General information

NPI: 1962620963
Provider Name (Legal Business Name): JOANNE MARIE SANTANA C.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 SECOND RD.
SUMMERTOWN TN
38483
US

IV. Provider business mailing address

320 MT. JOY RD.
HAMPSHIRE TN
38461
US

V. Phone/Fax

Practice location:
  • Phone: 931-964-2293
  • Fax: 931-964-2293
Mailing address:
  • Phone: 931-379-0440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberCPM0000000010
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: