Provider Demographics
NPI:1548655699
Name:DESTINE, PAULINE (NP)
Entity type:Individual
Prefix:MISS
First Name:PAULINE
Middle Name:
Last Name:DESTINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 DELAWARE DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1861
Mailing Address - Country:US
Mailing Address - Phone:740-703-8725
Mailing Address - Fax:
Practice Address - Street 1:5150 E MAIN ST
Practice Address - Street 2:105
Practice Address - City:WHITEHALL
Practice Address - State:OH
Practice Address - Zip Code:43213-2441
Practice Address - Country:US
Practice Address - Phone:614-328-5555
Practice Address - Fax:800-438-2166
Is Sole Proprietor?:No
Enumeration Date:2015-04-04
Last Update Date:2015-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH17196NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily