Provider Demographics
NPI:1295698322
Name:DESTEFANO, DANIEL (RN)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:DESTEFANO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9822 HOWE DR
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-2216
Mailing Address - Country:US
Mailing Address - Phone:505-306-4938
Mailing Address - Fax:
Practice Address - Street 1:9822 HOWE DR
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66206-2216
Practice Address - Country:US
Practice Address - Phone:505-306-4938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-12-05
Last Update Date:2025-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-150536-102163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine