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General NPI Number Information
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NPI Number | 1801924766
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES DESJARDINS MSN, APRN
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Gender | Male
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Dates
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Enumeration Date | 03/01/2007
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 668 E 12225 S STE 203
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City | DRAPER
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State | UT
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Zip | 84020-8385
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Country | US
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Telephone | 801-572-8255
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Fax | 801-572-8144
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Provider Business Mailing Address
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Address Line | PO BOX 1812
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City | DRAPER
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State | UT
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Zip | 84020-1812
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Country | US
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Telephone | 801-518-9203
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 377701-4405
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 377701-4405
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License Number State | UT
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