Provider Demographics
NPI:1508010125
Name:DISTEFANO, BARBARA (RN,BSN,CRNFA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:RN,BSN,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 628
Mailing Address - Street 2:
Mailing Address - City:FLAGTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08821-0628
Mailing Address - Country:US
Mailing Address - Phone:908-369-8793
Mailing Address - Fax:
Practice Address - Street 1:11 PETERS TERR
Practice Address - Street 2:
Practice Address - City:FLAGTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08821-0628
Practice Address - Country:US
Practice Address - Phone:908-369-8791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO08920600163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant