Provider Demographics
NPI:1598426322
Name:TARVER, DESTINY DAWN (CNM)
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:DAWN
Last Name:TARVER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:DESTINY
Other - Middle Name:DAWN
Other - Last Name:MAPLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:725 N HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-6914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 DUNWOODY DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015-9565
Practice Address - Country:US
Practice Address - Phone:717-218-1820
Practice Address - Fax:717-706-6735
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA666588163WM0102X
PAMW010669367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn