Provider Demographics
NPI:1699911206
Name:DESANTIS, ANNETTE M (RN)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:M
Last Name:DESANTIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-4804
Mailing Address - Country:US
Mailing Address - Phone:518-793-9362
Mailing Address - Fax:
Practice Address - Street 1:16 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-4804
Practice Address - Country:US
Practice Address - Phone:518-793-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY474687-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse