Provider Demographics
NPI:1962729988
Name:DESROSIERS, HANS (NURSE)
Entity type:Individual
Prefix:
First Name:HANS
Middle Name:
Last Name:DESROSIERS
Suffix:
Gender:M
Credentials:NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TILESTON ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1033
Mailing Address - Country:US
Mailing Address - Phone:857-719-3852
Mailing Address - Fax:
Practice Address - Street 1:23 TILESTON ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1033
Practice Address - Country:US
Practice Address - Phone:857-719-3852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALN65898164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse