Healthcare Provider Details

I. General information

NPI: 1528164209
Provider Name (Legal Business Name): BARBARA DESJARDINS RNC, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 CYPRESS ST
MANCHESTER NH
03103-3628
US

IV. Provider business mailing address

401 CYPRESS ST
MANCHESTER NH
03103-3628
US

V. Phone/Fax

Practice location:
  • Phone: 603-668-4111
  • Fax:
Mailing address:
  • Phone: 603-668-4111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number012629-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: