Provider Demographics
NPI:1497705586
Name:DESLOGES, ANN MARY (NP)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:MARY
Last Name:DESLOGES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:ANN
Other - Middle Name:MARY
Other - Last Name:DESLOGES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:39 ESSEX GREEN LN
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2919
Mailing Address - Country:US
Mailing Address - Phone:781-520-1233
Mailing Address - Fax:978-717-5626
Practice Address - Street 1:39 ESSEX GREEN LN
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2919
Practice Address - Country:US
Practice Address - Phone:781-520-1233
Practice Address - Fax:978-717-5626
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA138951363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner