| Doctor Name: | MR. ROBERT DESROSIERS |
| NPI Number: | 1013301621 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | APRN NP-C |
| License Number: | APRN00633 |
| Business Practice Address: | 11 Main St Store # 2065 Wakefield, RI - 028793562 |
| Business Phone Number: | 4017833384 |
| Business Fax Number: | |
| Mailing Address: | 975 Warwick Neck Ave, WARWICK |
| State: | RI |
| Postal Code: | 028896534 |
| Phone Number: | 4012866079 |
| Fax Number: | 4012866079 |
| NPI Enumeration Date: | 03/20/2015 |
| NPI Last Update Date: | 03/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | APRN00633 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | RI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |