Individual
MS. RENAY LEE DESROCHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
412 STRATTON HILL RD, WEST CHAZY, NY 12992-3630
(518) 493-4134
Mailing address
412 STRATTON HILL RD, WEST CHAZY, NY 12992-3630
(518) 493-4134
Taxonomy
Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
Primary
22379141
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02923393
—
NY
Enumeration date
04/17/2008
Last updated
04/17/2008
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