Provider Demographics
NPI:1700957578
Name:DESJARDINS, GERARD GILBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:GERARD
Middle Name:GILBERT
Last Name:DESJARDINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202
Mailing Address - Country:US
Mailing Address - Phone:575-622-4784
Mailing Address - Fax:
Practice Address - Street 1:113 E 17TH STREET
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-627-7000
Practice Address - Fax:575-627-7007
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR13732367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM30264OtherLOVELACE HEALTH PLAN
GA430055194OtherRAILROAD MEDICARE
NM14331OtherPRESBYTERIAN HEALTH PLAN
NMNM016018OtherBLUE CROSS
NM91215Medicaid
NM50655OtherPRESBYTERIAN SALUD
NM11148OtherLOVELACE SALUD
FL188124400OtherDEPT OF LABOR
FL188124400OtherDEPT OF LABOR