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Individual

MR. NICOLAS JUNIOR DESJARDINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
96 SUMMER ST APT 1, SOMERVILLE, MA 02143-2707
(617) 834-8784
Mailing address
96 SUMMER ST APT 1, SOMERVILLE, MA 02143-2707
(617) 834-8784

Taxonomy

Speciality
Code
Description
License number
State
174H00000X
Health Educator
PA6469
MA
207X00000X
Orthopaedic Surgery Physician
PA6469
MA
363A00000X
Physician Assistant
PA6469
MA
363AS0400X
Surgical Physician Assistant
Primary
PA6469
MA
405300000X
Prevention Professional
PA6469
MA

Other

Enumeration date
03/03/2018
Last updated
01/22/2021
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