Individual
MRS. MICHELLE DESTOUCHE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
241 WESTFIELD AVE, CLARK, NJ 07066-1547
(866) 389-2727
Mailing address
241 WESTFIELD AVE, CLARK, NJ 07066-1547
(866) 389-2727
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
26NR14342600
NJ
363LF0000X
Family Nurse Practitioner
Primary
26NJ14866000
NJ
Other
Enumeration date
09/11/2023
Last updated
10/06/2023
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