Provider Demographics
NPI:1225008592
Name:DESROCHERS, MARIAN J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MARIAN
Middle Name:J
Last Name:DESROCHERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:MARIAN
Other - Middle Name:J
Other - Last Name:GAMACHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:13 HIGHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:ALLENSTOWN
Mailing Address - State:NH
Mailing Address - Zip Code:03275-2622
Mailing Address - Country:US
Mailing Address - Phone:603-268-0332
Mailing Address - Fax:
Practice Address - Street 1:246 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02460-1639
Practice Address - Country:US
Practice Address - Phone:617-244-3322
Practice Address - Fax:617-244-1827
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH046248-23363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30342403Medicaid
NHNP4050Medicare ID - Type Unspecified
NH30342403Medicaid