Provider Demographics
NPI:1801508700
Name:PITZER, DESTINEE MARIE
Entity type:Individual
Prefix:
First Name:DESTINEE
Middle Name:MARIE
Last Name:PITZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DESTINEE
Other - Middle Name:MARIE
Other - Last Name:HISEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2745 PEADITTLE RD
Mailing Address - Street 2:
Mailing Address - City:MOATSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26405-8262
Mailing Address - Country:US
Mailing Address - Phone:304-612-5032
Mailing Address - Fax:
Practice Address - Street 1:2745 PEADITTLE RD
Practice Address - Street 2:
Practice Address - City:MOATSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26405-8262
Practice Address - Country:US
Practice Address - Phone:304-612-5032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-22
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant