Provider Demographics
NPI:1164836300
Name:DESROCHES, ANNE-MARIE
Entity Type:Individual
Prefix:
First Name:ANNE-MARIE
Middle Name:
Last Name:DESROCHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1575 TREMONT ST
Mailing Address - Street 2:#603
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02120-1677
Mailing Address - Country:US
Mailing Address - Phone:617-232-7830
Mailing Address - Fax:
Practice Address - Street 1:1575 TREMONT ST
Practice Address - Street 2:#603
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02120-1677
Practice Address - Country:US
Practice Address - Phone:617-232-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN166174163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse