Provider Demographics
NPI:1922374354
Name:DESTENO, MARYFRANCES LANOSA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARYFRANCES
Middle Name:LANOSA
Last Name:DESTENO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 HOLLY HILL LN
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6074
Mailing Address - Country:US
Mailing Address - Phone:203-863-4210
Mailing Address - Fax:
Practice Address - Street 1:55 HOLLY HILL LN
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6074
Practice Address - Country:US
Practice Address - Phone:203-863-4210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2323363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2323OtherAPRN LICENSE