Provider Demographics
NPI:1255827341
Name:DESTIN, MARIE
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:DESTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 DIAUTO DR
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:MA
Mailing Address - Zip Code:02368-4536
Mailing Address - Country:US
Mailing Address - Phone:178-188-5725
Mailing Address - Fax:
Practice Address - Street 1:44 DIAUTO DR
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:MA
Practice Address - Zip Code:02368-4536
Practice Address - Country:US
Practice Address - Phone:178-188-5725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker