Provider Demographics
NPI:1366051666
Name:DESROSIER, LINDSEY (NP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:DESROSIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1009
Mailing Address - Country:US
Mailing Address - Phone:207-868-2796
Mailing Address - Fax:207-868-2799
Practice Address - Street 1:4 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1009
Practice Address - Country:US
Practice Address - Phone:207-868-2796
Practice Address - Fax:207-868-2799
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-23
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP201205363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty