Provider Demographics
NPI:1871614420
Name:NUNEZ-SANTIAGO, IBIS DANITZIA (PHD)
Entity type:Individual
Prefix:DR
First Name:IBIS
Middle Name:DANITZIA
Last Name:NUNEZ-SANTIAGO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2034
Mailing Address - Street 2:
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-2034
Mailing Address - Country:US
Mailing Address - Phone:828-586-8160
Mailing Address - Fax:828-586-8209
Practice Address - Street 1:119 BOONE RIDGE DR
Practice Address - Street 2:STE 201
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37615-4998
Practice Address - Country:US
Practice Address - Phone:423-282-1480
Practice Address - Fax:423-928-1353
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4066103T00000X
SC1174103T00000X
TN3389103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist