Provider Demographics
NPI:1730458068
Name:DESROCHES, DIANE ADELE MOUNT
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:ADELE MOUNT
Last Name:DESROCHES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459R WALLINGFORD RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:CT
Mailing Address - Zip Code:06422-1124
Mailing Address - Country:US
Mailing Address - Phone:860-349-1989
Mailing Address - Fax:
Practice Address - Street 1:459R WALLINGFORD RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:CT
Practice Address - Zip Code:06422-1124
Practice Address - Country:US
Practice Address - Phone:860-349-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTE57219163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse