Individual
MS. MICHELE JEAN DECASTRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
1020 SANSOM ST, SUITE 239, PHILADELPHIA, PA 19107-5002
(215) 955-6844
Mailing address
111 S 11TH ST, GIBBON 8100, PHILADELPHIA, PA 19107-4824
(215) 955-9207
(215) 503-6134
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
SP010197
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102645043
—
PA
Enumeration date
03/30/2009
Last updated
02/24/2016
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