Individual
MARIE DESTINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2250 HICKORY RD, SUITE 240, PLYMOUTH MEETING, PA 19462-1047
(800) 879-4471
Mailing address
251 FALLS CHURCH ST SW, PALM BAY, FL 32908-7180
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN5180942
FL
Other
Enumeration date
10/27/2009
Last updated
10/27/2009
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