Individual
DESIREE VIVIANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
448 WEST RD, BOWDOIN, ME 04287-7237
(516) 456-8812
Mailing address
448 WEST RD, BOWDOIN, ME 04287-7237
(516) 456-8812
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
017990-1
NY
363A00000X
Physician Assistant
Primary
PA2178
ME
Other
Enumeration date
09/30/2014
Last updated
09/12/2022
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