Individual
MR. RICHARD J. DESAUTEL
Active
Individual
MR. RICHARD J. DESAUTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
004966
CT
363LG0600X
Gerontology Nurse Practitioner
049762-23
NH
363LG0600X
Gerontology Nurse Practitioner
153541
MA
363LG0600X
Gerontology Nurse Practitioner
AP081740
ME
363LG0600X
Gerontology Nurse Practitioner
CNP01488
NM
363LG0600X
Gerontology Nurse Practitioner
Primary
F340630
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03213898
—
NY
01
—
200213435
CDPHP
NY
01
—
3012611
MVP
NY
01
—
431894499
MEDICAID - MAINECARE
ME
Enumeration date
06/27/2007
Last updated
12/20/2018
Update your record
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