Doctor Name: | SUSAN E DESROCHES |
NPI Number: | 1033165253 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 201038 |
Business Practice Address: | 1501 Tate Blvd Se Suite 201 Hickory, NC - 286024243 |
Business Phone Number: | 8283224140 |
Business Fax Number: | 8283223767 |
Mailing Address: | Po Box 38, HICKORY |
State: | NC |
Postal Code: | 286030038 |
Phone Number: | 8283224140 |
Fax Number: | 8283223767 |
NPI Enumeration Date: | 05/26/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 201038 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |