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General NPI Number Information
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NPI Number | 1679188494
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Entity Type | Organization
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Legal Business Name | DESTA ANTHONY MOBILE NP ADULT HEALTH, PLLC
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Dates
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Enumeration Date | 09/09/2020
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 8241 PENSTOCK WAY
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City | MANLIUS
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State | NY
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Zip | 13104-9401
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Country | US
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Telephone | 315-413-3848
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Fax | 315-692-4292
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Provider Business Mailing Address
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Address Line | 8241 PENSTOCK WAY
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City | MANLIUS
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State | NY
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Zip | 13104-9401
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Country | US
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Telephone | 315-559-1965
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Fax | 833-606-0692
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Authorized Official
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Title or Position | OWNER
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Name | DESTA ROWENA ANTHONY
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Credential |
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Telephone | 315-559-1965
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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