Jacqueline Lee Destro, C.R.N.P.
Individual provider Active NPI Pediatric Nurse Practitioner · Wilkinsburg, PA
NPI 1164568465 · NPPES record last updated Jul 15, 2013
Key facts
- NPI
- 1164568465
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- UP001881D (PA)
- Practice address
- 221 Penn Ave
Wilkinsburg, PA 15221-2118 - Phone
- (412) 865-6589
- NPI assigned
- Jan 30, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| UP001881D | PA | MD | Pediatric Nurse Practitioner |
Interoperability endpoints
- jdestro@direct.excelahealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | UP001881D | PA | Yes |
Addresses
Primary practice location
221 Penn Ave
Wilkinsburg, PA 15221-2118
Mailing address
240 Woodside Rd
Pittsburgh, PA 15221-3638
Phone (412) 247-1704
Other providers in Wilkinsburg, PA
- Christina Chukwuedo
- William T Conklin
- Elwin M Cotman
- Sheila Marie Craig
- Jaclyn Ava Deem
- Abigail Jean Dudzic
- Krysta Enchill
- Stacy Fincher
- Kevin Flaherty
- Rikell Shawntae Ford
All providers in Wilkinsburg, PA · Pediatric Nurse Practitioner in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.