Provider Demographics
NPI:1285388769
Name:FAUCETTE, DESEAN ROBERT
Entity type:Individual
Prefix:
First Name:DESEAN
Middle Name:ROBERT
Last Name:FAUCETTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 POST OFFICE RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-9998
Mailing Address - Country:US
Mailing Address - Phone:240-353-4755
Mailing Address - Fax:
Practice Address - Street 1:150 POST OFFICE RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-9998
Practice Address - Country:US
Practice Address - Phone:240-353-4755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDF-230-139-745-577376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF-230-139-745-577OtherN/A