Provider Demographics
NPI:1740569508
Name:DISTEFANO, MARIA CHRISTINA (FNP)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:CHRISTINA
Last Name:DISTEFANO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 OLD OAK RD
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18902-8811
Mailing Address - Country:US
Mailing Address - Phone:215-410-2573
Mailing Address - Fax:
Practice Address - Street 1:4602 OLD OAK RD
Practice Address - Street 2:
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18902-8811
Practice Address - Country:US
Practice Address - Phone:215-410-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006071B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily