Provider Demographics
NPI:1972142479
Name:DESMOND, ANNE MARIE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:MARIE
Last Name:DESMOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:5 PINECONE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1244
Mailing Address - Country:US
Mailing Address - Phone:617-872-1354
Mailing Address - Fax:
Practice Address - Street 1:5 PINECONE LN
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-1244
Practice Address - Country:US
Practice Address - Phone:617-872-1354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA788394363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health