Provider Demographics
NPI:1174242705
Name:FLANDERS, DESIRAE CRYSTAL (MSN, RN)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:CRYSTAL
Last Name:FLANDERS
Suffix:
Gender:F
Credentials:MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 N CORSICA PL
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3131
Mailing Address - Country:US
Mailing Address - Phone:480-284-2645
Mailing Address - Fax:
Practice Address - Street 1:399 N CORSICA PL
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3131
Practice Address - Country:US
Practice Address - Phone:480-284-2645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN157741163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse