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General NPI Number Information
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NPI Number | 1104382084
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Entity Type | Individual
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Provider Name | MYRLENE DESROSIERS FNP
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 2020 MCGEE RD
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City | SNELLVILLE
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State | GA
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Zip | 30078-2992
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Country | US
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Telephone | 877-749-7428
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Fax | 512-628-3314
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Provider Business Mailing Address
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Address Line | 1776 WOODSTEAD CT STE 208
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City | THE WOODLANDS
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State | TX
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Zip | 77380-1480
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Country | US
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Telephone | 877-749-7428
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Fax | 512-628-3314
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN126935
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License Number State | GA
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