Provider Demographics
NPI:1487268652
Name:SANTOS, ANN MICHELLE
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:SANTOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 PARK ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01841-2517
Mailing Address - Country:US
Mailing Address - Phone:978-685-1770
Mailing Address - Fax:978-686-4478
Practice Address - Street 1:54 CEDAR LN
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-3202
Practice Address - Country:US
Practice Address - Phone:508-265-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN213568163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse