Healthcare Provider Details

I. General information

NPI: 1922058783
Provider Name (Legal Business Name): MARIE CARMEL DESIRE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 S WORTHEN ST
WENATCHEE WA
98801
US

IV. Provider business mailing address

145 S WORTHEN ST
WENATCHEE WA
98801-3081
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-6761
  • Fax: 509-662-3182
Mailing address:
  • Phone: 509-662-6761
  • Fax: 509-662-3182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00044463
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: