Healthcare Provider Details

I. General information

NPI: 1164103958
Provider Name (Legal Business Name): KATHRYN P DESROSIERS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W COLE RD STE 101
BIDDEFORD ME
04005-9431
US

IV. Provider business mailing address

22 W COLE RD STE 101
BIDDEFORD ME
04005-9431
US

V. Phone/Fax

Practice location:
  • Phone: 207-780-6565
  • Fax: 207-800-4932
Mailing address:
  • Phone: 207-780-6565
  • Fax: 207-800-4932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberCNP231281
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: