Individual
ERLINE DESTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
780 ALBANY ST, BOSTON, MA 02118-2755
(857) 654-1000
Mailing address
780 ALBANY ST, BOSTON, MA 02118-2755
(857) 654-1000
(857) 654-1100
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN2316809
MA
176B00000X
Midwife
MW204
FL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN2316809
MA
Other
Enumeration date
10/24/2008
Last updated
07/25/2023
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