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General NPI Number Information
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NPI Number | 1245812692
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Entity Type | Individual
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Provider Name | LISETTE SANTISTEBAN FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 05/06/2022
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Provider Practice Location Address
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Address Line | 800 ROUTE 17M
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City | MIDDLETOWN
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State | NY
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Zip | 10940-1306
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Country | US
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Telephone | 845-341-0515
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Fax | 845-341-0710
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Provider Business Mailing Address
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Address Line | 12 CANE CT
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City | GOSHEN
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State | NY
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Zip | 10924-1306
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Country | US
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Telephone | 347-624-1508
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F347525-01
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License Number State | NY
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