Individual
JEFFREY S DESMARTEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4608 W 36TH AVE, DENVER, CO 80212-2009
(303) 379-9371
Mailing address
4608 W 36TH AVE, DENVER, CO 80212-2009
(303) 379-9371
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
180328
CO
164W00000X
Licensed Practical Nurse
Primary
990339
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78276837
—
CO
01
—
P01063720
RR MEDICARE PTAN
CO
Enumeration date
03/19/2012
Last updated
09/06/2012
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