Provider Demographics
NPI:1356661474
Name:DESJARDINS, DESIREE A (FNP)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:A
Last Name:DESJARDINS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:A
Other - Last Name:STRIHA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3108 S BROADWAY STE H
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3127
Mailing Address - Country:US
Mailing Address - Phone:701-852-8502
Mailing Address - Fax:701-425-0402
Practice Address - Street 1:3108 S BROADWAY STE H
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-3127
Practice Address - Country:US
Practice Address - Phone:701-852-8502
Practice Address - Fax:701-425-0402
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR27966363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1475416Medicaid