Healthcare Provider Details

I. General information

NPI: 1972075224
Provider Name (Legal Business Name): MELISSA ANN DESROSIERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 12/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MESSENGER ST
PLAINVILLE MA
02762-2258
US

IV. Provider business mailing address

60 MESSENGER ST
PLAINVILLE MA
02762-2258
US

V. Phone/Fax

Practice location:
  • Phone: 508-809-6378
  • Fax: 508-809-6366
Mailing address:
  • Phone: 508-809-6378
  • Fax: 508-809-6366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN241902
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: