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NPI Code Detail

MEDICARE: MS. RENEE M DESROSIERS PA C

MEDICARE: MS. RENEE M DESROSIERS PA C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA01840RI

General Provider Information

NPI Number : 1922088988
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RENEE M DESROSIERS PA C
Provider Business Mailing Address
First Line : 15 LA SALLE SQ
Second Line :
City : PROVIDENCE
State : RI
Zip : 02903-1814
Country : US
Telephone Number : 401-444-6779
Fax Number : 401-444-6912
Provider Business Practice Location Address
First Line : 11 FRIENDSHIP ST
Second Line :
City : NEWPORT
State : RI
Zip : 02840-2209
Country : US
Telephone Number : 401-845-1652
Fax Number : 401-845-1198
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2006
Last Update Date : 12/11/2025

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