| Doctor Name: | MRS. DIANE LYNN DESTEFANO |
| NPI Number: | 1063797314 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 209009671 |
| Business Practice Address: | 1123 Chestnut St Mount Carmel, IL - 628631212 |
| Business Phone Number: | 6182634376 |
| Business Fax Number: | 6182627970 |
| Mailing Address: | 1123 Chestnut St, MOUNT CARMEL |
| State: | IL |
| Postal Code: | 628631212 |
| Phone Number: | 6182634376 |
| Fax Number: | 6182627970 |
| NPI Enumeration Date: | 10/19/2011 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | 209009671 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |