Basic Information
| Provider Information | |||||||||
| NPI: | 1295087351 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESGROTTES | ||||||||
| FirstName: | XAVIERA | ||||||||
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| Credential: | LPN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 SECORA RD | ||||||||
| Address2: | APT L 15 | ||||||||
| City: | MONSEY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109523729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458212088 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 99 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | SUFFERN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109016026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453574500 | ||||||||
| FaxNumber: | 8453575039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2012 | ||||||||
| LastUpdateDate: | 10/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164W00000X | 287808 | NY | Y | Nursing Service Providers | Licensed Practical Nurse |
No ID Information.