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General NPI Number Information
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NPI Number | 1700957578
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Entity Type | Individual
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Provider Name | GERARD GILBERT DESJARDINS CRNA
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Gender | Male
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Dates
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Enumeration Date | 11/13/2006
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Last Update Date | 06/03/2008
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Provider Practice Location Address
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Address Line | 113 E 17TH STREET
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City | ROSWELL
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State | NM
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Zip | 88201
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Country | US
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Telephone | 575-627-7000
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Fax | 575-627-7007
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Provider Business Mailing Address
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Address Line | PO BOX 664
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City | ROSWELL
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State | NM
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Zip | 88202
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Country | US
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Telephone | 575-622-4784
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Fax |
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | R13732
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License Number State | NM
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