Provider Demographics
NPI:1184083446
Name:DESIR, ROSELANDE ESTIMABLE (CRNA, APRN)
Entity type:Individual
Prefix:
First Name:ROSELANDE
Middle Name:ESTIMABLE
Last Name:DESIR
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:ROSELANDE
Other - Middle Name:
Other - Last Name:ESTIMABLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA, APRN
Mailing Address - Street 1:502 GOLF DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-1484
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 CEDAR ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3206
Practice Address - Country:US
Practice Address - Phone:617-331-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2018-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7471367500000X
NJ26NR18496400390200000X
NHNH065732-21390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program