Provider Demographics
NPI:1497488423
Name:DESTEFANO, DANIEL (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DESTEFANO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-9998
Mailing Address - Country:US
Mailing Address - Phone:202-638-0750
Mailing Address - Fax:202-638-0749
Practice Address - Street 1:600 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4316
Practice Address - Country:US
Practice Address - Phone:202-638-0750
Practice Address - Fax:202-638-0749
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184882363LF0000X
DCNP1056473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty