MEDICARE: MRS. ELIZABETH HAYES SANTIAGO NNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LN0000X	Neonatal Nurse Practitioner	5010861	NC

General Provider Information

NPI Number	:	1013497312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH HAYES SANTIAGO NNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 275
Second Line	:
City	:	WINTERVILLE
State	:	NC
Zip	:	28590-0275
Country	:	US
Telephone Number	:	484-274-1421
Fax Number	:

Provider Business Practice Location Address
First Line	:	2102 STANTONSBURG RD
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27834-2783
Country	:	US
Telephone Number	:	252-847-4378
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2018
Last Update Date	:	12/27/2021

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