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NPI Code Detail

MEDICARE: ANDREA LYNN DESTORIES M.D.

MEDICARE: ANDREA LYNN DESTORIES M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician34944264NV
22084P0800XPsychiatry PhysicianMD6088082WA

General Provider Information

NPI Number : 1114285962
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA LYNN DESTORIES M.D.
Provider Business Mailing Address
First Line : 1340 E. 9TH ST.
Second Line :
City : RENO
State : NV
Zip : 89512
Country : US
Telephone Number : 775-323-0478
Fax Number :
Provider Business Practice Location Address
First Line : 1240 E 9TH ST
Second Line :
City : RENO
State : NV
Zip : 89512-2964
Country : US
Telephone Number : 775-323-0478
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/30/2012
Last Update Date : 03/15/2026

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