Healthcare Provider Details

I. General information

NPI: 1598426322
Provider Name (Legal Business Name): DESTINY DAWN TARVER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DESTINY DAWN MAPLES

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 DUNWOODY DR
CARLISLE PA
17015-9565
US

IV. Provider business mailing address

725 N HIGHLANDS DR
HARRISBURG PA
17111-6914
US

V. Phone/Fax

Practice location:
  • Phone: 717-218-1820
  • Fax: 717-706-6735
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number666588
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberMW010669
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: