Provider Demographics
NPI:1245795277
Name:CHRISTIAN, DESTINEY (LPN)
Entity Type:Individual
Prefix:
First Name:DESTINEY
Middle Name:
Last Name:CHRISTIAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-3738
Mailing Address - Country:US
Mailing Address - Phone:215-688-3835
Mailing Address - Fax:
Practice Address - Street 1:5500 TABOR AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-2124
Practice Address - Country:US
Practice Address - Phone:215-245-2131
Practice Address - Fax:215-245-5258
Is Sole Proprietor?:No
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN309611164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse