Doctor Name: | MISS CASSANDRA S. DESTEFANO |
NPI Number: | 1326455791 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | MA056943 |
Business Practice Address: | 126 W Church St Dillsburg, PA - 170191280 |
Business Phone Number: | 7174322411 |
Business Fax Number: | |
Mailing Address: | 2238 Manchester Blvd, HARRISBURG |
State: | PA |
Postal Code: | 171121030 |
Phone Number: | 7175742712 |
Fax Number: | |
NPI Enumeration Date: | 07/17/2014 |
NPI Last Update Date: | 07/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | MA056943 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |