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Organization
DESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC
Active
Organization
DESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESTA ROWENA ANTHONY (OWNER)
(315) 559-1965
Entity
Organization
Contact information
Practice address
8241 PENSTOCK WAY, MANLIUS, NY 13104-9401
(315) 413-3848
(315) 692-4292
Mailing address
8241 PENSTOCK WAY, MANLIUS, NY 13104-9401
(315) 559-1965
(833) 606-0692
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/09/2020
Last updated
11/28/2025
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