Provider Demographics
NPI:1679389456
Name:DESROSIERS, NICKOLAS M
Entity type:Individual
Prefix:MR
First Name:NICKOLAS
Middle Name:M
Last Name:DESROSIERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-9804
Mailing Address - Country:US
Mailing Address - Phone:330-303-6480
Mailing Address - Fax:
Practice Address - Street 1:318 NOTTINGHAM WAY
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9804
Practice Address - Country:US
Practice Address - Phone:330-303-6480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care