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General NPI Number Information
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NPI Number | 1417031253
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Entity Type | Individual
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Provider Name | NICHOLAS DESTEFANO CRNA
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Gender | Male
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 8500 N ORACLE RD STE 150
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City | TUCSON
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State | AZ
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Zip | 85704-6511
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Country | US
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Telephone | 520-462-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 1450 WESTERN AVE STE 102 ANESTHESIA GROUP OF ALBANY, PC
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City | ALBANY
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State | NY
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Zip | 12203-3539
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Country | US
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Telephone | 518-463-0050
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Fax | 518-207-2973
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 524397
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 300626
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License Number State | AZ
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