MEDICARE: GREGORY S DESTEFANO APRN

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
1	363LA2200X	Adult Health Nurse Practitioner	002291	CT

General Provider Information

NPI Number	:	1720081110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY S DESTEFANO APRN

Provider Business Mailing Address
First Line	:	5 SHERWOOD DR
Second Line	:
City	:	NORTH HAVEN
State	:	CT
Zip	:	06473-2129
Country	:	US
Telephone Number	:	203-645-5053
Fax Number	:

Provider Business Practice Location Address
First Line	:	NP RESOURCES, LLC
Second Line	:	SIX CORPORATE DRIVE, SUITE 420
City	:	SHELTON
State	:	CT
Zip	:	06484
Country	:	US
Telephone Number	:	203-925-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/08/2007

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