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NPI Code Detail

MEDICARE: MRS. MICHELLE DESTOUCHE APN

MEDICARE: MRS. MICHELLE DESTOUCHE APN
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
1163W00000XRegistered Nurse26NR14342600NJ
2363LF0000XFamily Nurse Practitioner26NJ14866000NJ

General Provider Information

NPI Number : 1801673207
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE DESTOUCHE APN
Provider Business Mailing Address
First Line : 241 WESTFIELD AVE
Second Line :
City : CLARK
State : NJ
Zip : 07066-1547
Country : US
Telephone Number : 866-389-2727
Fax Number :
Provider Business Practice Location Address
First Line : 241 WESTFIELD AVE
Second Line :
City : CLARK
State : NJ
Zip : 07066-1547
Country : US
Telephone Number : 866-389-2727
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2023
Last Update Date : 10/06/2023

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Directions to “ MRS. MICHELLE DESTOUCHE APN” Practice Location

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