| Doctor Name: | MRS. JACQUELINE LEE DESTRO |
| NPI Number: | 1164568465 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | C.R.N.P. |
| License Number: | UP001881D |
| Business Practice Address: | 221 Penn Ave Wilkinsburg, PA - 152212118 |
| Business Phone Number: | 4128656589 |
| Business Fax Number: | |
| Mailing Address: | 240 Woodside Rd, PITTSBURGH |
| State: | PA |
| Postal Code: | 152213638 |
| Phone Number: | 4122471704 |
| Fax Number: | |
| NPI Enumeration Date: | 01/30/2007 |
| NPI Last Update Date: | 07/15/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP0200X |
| License Number: | UP001881D |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |