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General NPI Number Information
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NPI Number | 1811194558
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Entity Type | Individual
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Provider Name | RICHARD J. DESAUTEL NP
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 88 COUNTY ROUTE 26A
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City | STUYVESANT
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State | NY
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Zip | 12173-2410
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Country | US
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Telephone | 413-429-5139
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Fax |
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Provider Business Mailing Address
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Address Line | 88 COUNTY ROUTE 26A
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City | STUYVESANT
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State | NY
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Zip | 12173-2410
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Country | US
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Telephone | 413-429-5139
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 004966
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP081740
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License Number State | ME
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | CNP01488
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 049762-23
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License Number State | NH
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 153541
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License Number State | MA
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Taxonomy #6
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | F340630
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License Number State | NY
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