Individual
MR. MICHAEL CHARLES DESJARDINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSN, APRN
Contact information
Practice address
668 E 12225 S STE 203, DRAPER, UT 84020-8385
(801) 572-8255
(801) 572-8144
Mailing address
PO BOX 1812, DRAPER, UT 84020-1812
(801) 518-9203
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
377701-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
377701-4405
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3777014408
LICENSE
UT
Enumeration date
03/01/2007
Last updated
09/17/2020
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