Provider Demographics
NPI:1427651033
Name:DI STEFANO, VIVIANA LORRAINE
Entity type:Individual
Prefix:MRS
First Name:VIVIANA
Middle Name:LORRAINE
Last Name:DI STEFANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 DAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:EAST EARL
Mailing Address - State:PA
Mailing Address - Zip Code:17519-9275
Mailing Address - Country:US
Mailing Address - Phone:612-709-0608
Mailing Address - Fax:
Practice Address - Street 1:25 DAWKINS DR
Practice Address - Street 2:
Practice Address - City:EAST EARL
Practice Address - State:PA
Practice Address - Zip Code:17519-9275
Practice Address - Country:US
Practice Address - Phone:612-709-0608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
IDPA-2565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant