Provider Demographics
NPI:1982488953
Name:DESVERGNES, DESIREE KASMIRA (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:KASMIRA
Last Name:DESVERGNES
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 TUG HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:RI
Mailing Address - Zip Code:02898-1105
Mailing Address - Country:US
Mailing Address - Phone:508-685-5081
Mailing Address - Fax:
Practice Address - Street 1:19 TUG HOLLOW RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:RI
Practice Address - Zip Code:02898-1105
Practice Address - Country:US
Practice Address - Phone:508-685-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIL-302158163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant