Provider Demographics
NPI:1639749963
Name:DISTEFANO, ERICKA MARIE (FNP, ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:MARIE
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:FNP, ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 EXPLORER ST
Mailing Address - Street 2:
Mailing Address - City:GWINN
Mailing Address - State:MI
Mailing Address - Zip Code:49841-2813
Mailing Address - Country:US
Mailing Address - Phone:906-346-9275
Mailing Address - Fax:906-372-3230
Practice Address - Street 1:301 EXPLORER ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-2813
Practice Address - Country:US
Practice Address - Phone:906-346-9275
Practice Address - Fax:906-372-3230
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704293102363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily