Individual
DESTA ROWENA ANTHONY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
8241 PENSTOCK WAY, MANLIUS, NY 13104-9401
(315) 559-1965
(833) 606-0692
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
F303332
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02207207
—
NY
Enumeration date
07/31/2006
Last updated
11/28/2025
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