Provider Demographics
NPI:1982277158
Name:DESROCHER, ERIN REGAN (RN, NP-C)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:REGAN
Last Name:DESROCHER
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 DORCHESTER AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5699
Mailing Address - Country:US
Mailing Address - Phone:617-505-1036
Mailing Address - Fax:
Practice Address - Street 1:2110 DORCHESTER AVE STE 209
Practice Address - Street 2:
Practice Address - City:DORCHESTER
Practice Address - State:MA
Practice Address - Zip Code:02124-5699
Practice Address - Country:US
Practice Address - Phone:617-505-1036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2347009163W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse