Provider Demographics
NPI:1972574788
Name:DESIMONE, M. ELAYNE (NP)
Entity type:Individual
Prefix:DR
First Name:M.
Middle Name:ELAYNE
Last Name:DESIMONE
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 1:900 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-1656
Mailing Address - Country:US
Mailing Address - Phone:610-892-2888
Mailing Address - Fax:
Practice Address - Street 1:900 WINDING LN
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-1656
Practice Address - Country:US
Practice Address - Phone:610-892-2888
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007112363LA2200X
NYF300330-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY90V311Medicare ID - Type Unspecified