Provider Demographics
NPI:1386237311
Name:SANTIAGO, LESLEY MARIE (LPN)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:MARIE
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1377
Mailing Address - Country:US
Mailing Address - Phone:585-775-6200
Mailing Address - Fax:
Practice Address - Street 1:16 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1377
Practice Address - Country:US
Practice Address - Phone:585-775-6200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-20
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00313795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty