Individual
LAURA ELLEN DISTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
(617) 355-6000
Mailing address
300 LONGWOOD AVE, BOSTON, MA 02115-5724
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN2260431
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RN2260431
MA NURSING LICENSE
MA
Enumeration date
06/23/2017
Last updated
06/23/2017
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