MEDICARE: AMY D SANTIAGO APN

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	363L00000X	Nurse Practitioner	APRN001935	NV

General Provider Information

NPI Number	:	1578940490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY D SANTIAGO APN

Provider Business Mailing Address
First Line	:	700 SHADOW LN
Second Line	:	STE 240
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-4158
Country	:	US
Telephone Number	:	702-733-2982
Fax Number	:	702-733-3824

Provider Business Practice Location Address
First Line	:	4432 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-7825
Country	:	US
Telephone Number	:	702-733-2982
Fax Number	:	702-733-3824

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

Provider Enumeration Date	:	04/29/2015
Last Update Date	:	10/20/2021

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