| NPI | 1639708340 |
|---|---|
| Former Name | STEPHANIE DESTAFNEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology (Licence: PA SP021677) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: PA SP021677) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2021-01-04 |