Individual
MRS. DIANE LYNN DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1123 CHESTNUT ST, MOUNT CARMEL, IL 62863-1212
(618) 263-4376
(618) 262-7970
Mailing address
1123 CHESTNUT ST, MOUNT CARMEL, IL 62863-1212
(618) 263-4376
(618) 262-7970
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
209009671
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
209009671
ILLINOIS APN LICENSE
IL
01
—
3007204
KY LIC
KY
01
—
71003775A
IN LICENSE
IN
Enumeration date
10/19/2011
Last updated
06/10/2014
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