Basic Information
| Provider Information | |||||||||
| NPI: | 1700957578 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DESJARDINS | ||||||||
| FirstName: | GERARD | ||||||||
| MiddleName: | GILBERT | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 664 | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756224784 | ||||||||
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| Practice Location | |||||||||
| Address1: | 113 E 17TH STREET | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756277000 | ||||||||
| FaxNumber: | 5756277007 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/13/2006 | ||||||||
| LastUpdateDate: | 06/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R13732 | NM | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 30264 | 01 | NM | LOVELACE HEALTH PLAN | OTHER | 430055194 | 01 | GA | RAILROAD MEDICARE | OTHER | 14331 | 01 | NM | PRESBYTERIAN HEALTH PLAN | OTHER | NM016018 | 01 | NM | BLUE CROSS | OTHER | 91215 | 05 | NM | MEDICAID | 50655 | 01 | NM | PRESBYTERIAN SALUD | OTHER | 11148 | 01 | NM | LOVELACE SALUD | OTHER | 188124400 | 01 | FL | DEPT OF LABOR | OTHER |