Healthcare Provider Details

I. General information

NPI: 1164930574
Provider Name (Legal Business Name): DESTIN LYNN CONTI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2018
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 MEMORIAL DR
FARRELL PA
16121-1357
US

IV. Provider business mailing address

1208 UNION VALLEY RD
WAMPUM PA
16157-7210
US

V. Phone/Fax

Practice location:
  • Phone: 724-981-3500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number119432
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: