Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 175M00000X | Lay Midwife | 96077 | TX |
Y | 176B00000X | Midwife | 96077 | TX |
NPI | 1023130465 |
---|---|
Provider Name | Robin Destefano |
First Address | Farmersville, TX 75442-6605 |
Second Address | Farmersville, TX 75442-6605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2007 |
Last Update Date | 10/04/2018 |