Provider Demographics
NPI:1316316458
Name:DESTINO, GAELYN (RN, BSN, CLC)
Entity type:Individual
Prefix:
First Name:GAELYN
Middle Name:
Last Name:DESTINO
Suffix:
Gender:F
Credentials:RN, BSN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1242
Mailing Address - Country:US
Mailing Address - Phone:978-290-1031
Mailing Address - Fax:
Practice Address - Street 1:325 HIGH ST
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1242
Practice Address - Country:US
Practice Address - Phone:978-290-1031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-18
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2278998163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant