Provider Demographics
NPI:1659251973
Name:SANTANA, EMILY MAE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:MAE
Last Name:SANTANA
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 1:516 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:IL
Mailing Address - Zip Code:61252-1455
Mailing Address - Country:US
Mailing Address - Phone:815-440-0834
Mailing Address - Fax:
Practice Address - Street 1:516 8TH AVE
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:IL
Practice Address - Zip Code:61252-1455
Practice Address - Country:US
Practice Address - Phone:815-440-0834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program