Basic Information
| Provider Information | |||||||||
| NPI: | 1700975232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANTOS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1120 PINE ST | ||||||||
| Address2: | |||||||||
| City: | STANLEY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 547681297 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156445571 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2116 CRAIG ROAD | ||||||||
| Address2: | |||||||||
| City: | EAU CLAIRE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 54701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7158584691 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 109944 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 109944 | 01 | WI | WI LIC | OTHER | 43370600 | 05 | WI | MEDICAID |