Provider Demographics
NPI:1023130465
Name:DESTEFANO, ROBIN (LM, CPM)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:DESTEFANO
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 COUNTY ROAD 604
Mailing Address - Street 2:
Mailing Address - City:FARMERSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75442-6605
Mailing Address - Country:US
Mailing Address - Phone:214-415-4254
Mailing Address - Fax:972-782-7118
Practice Address - Street 1:1845 COUNTY ROAD 604
Practice Address - Street 2:
Practice Address - City:FARMERSVILLE
Practice Address - State:TX
Practice Address - Zip Code:75442-6605
Practice Address - Country:US
Practice Address - Phone:214-415-4254
Practice Address - Fax:972-782-7118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX96077175M00000X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, Lay