Provider Demographics
NPI:1538154349
Name:SANTUCCI, LORRAINE MICHELLE (PHD RN APNC)
Entity type:Individual
Prefix:MS
First Name:LORRAINE
Middle Name:MICHELLE
Last Name:SANTUCCI
Suffix:
Gender:F
Credentials:PHD RN APNC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7367
Mailing Address - Country:US
Mailing Address - Phone:856-690-0612
Mailing Address - Fax:856-690-0627
Practice Address - Street 1:1014 N HIGH ST
Practice Address - Street 2:
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-2527
Practice Address - Country:US
Practice Address - Phone:856-690-0627
Practice Address - Fax:856-690-0627
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NN07752400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
088413Medicare ID - Type UnspecifiedGROUP NUMBER
S43023Medicare UPIN
901468TWOMedicare ID - Type Unspecified