Provider Demographics
NPI:1164103958
Name:DESROSIERS, KATHRYN P (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:P
Last Name:DESROSIERS
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 1:22 W COLE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9431
Mailing Address - Country:US
Mailing Address - Phone:207-780-6565
Mailing Address - Fax:207-800-4932
Practice Address - Street 1:22 W COLE RD STE 101
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9431
Practice Address - Country:US
Practice Address - Phone:207-780-6565
Practice Address - Fax:207-800-4932
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MECNP231281207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine