DESIREE ANDERSON (NPI# 1295093912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295093912 |
| Entity Type | Individual |
| Full Name | DESIREE ANDERSON |
| Other Name | DESIREE LASTRAPES |
| Credential | IDMT |
| Practice Address |
208 W Casablanca Ave Cannon Afb NM 88103-5009 |
| Practice Telephone | 8502178587 |
| Mailing Telephone | 8502178587 |
| Enumeration Date | 2012-05-01 |
| Last Update Date | 2012-05-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285140350 | Desiree Anderson | Registered Nurse | 3308 Tulane Ave, New Orleans, LA 70119-7100 | 2017-12-27 |
| Street Address |
208 W CASABLANCA AVE |
| City | CANNON AFB |
| State | NM |
| Zip Code | 88103-5009 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396217170 | Nathanael Hand | Dietitian, Registered | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2018-12-18 |
| 1306228325 | Katherine Milam | Family Medicine | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2015-06-25 |
| 1144504085 | Christopher Mclaughlin | Internal Medicine | 208 W Casablanca Ave, 27 Soamds, Cannon Afb, NM 88103-5009 | 2011-10-10 |
| 1649503806 | Fawn Nicole Jones | Social Worker | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-09-04 |
| 1912139668 | Jessica Marie Pothast | Pharmacist | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-08-13 |
| 1083844054 | Lindsay Vincent | Military Health Care Provider | 208 W Casablanca Ave, 27 Somdg, Cannon Afb, NM 88103-5009 | 2009-07-23 |
| 1639313125 | Andrew Springstead | Military Health Care Provider | 208 W Casablanca Ave, 27somdg, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| 1366686842 | Steven Brandon Yates | Military Health Care Provider | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| 1740426923 | Justin David Wright | Physician Assistant | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2008-12-18 |
| 1104071729 | Donald Joseph Trigg | Physician Assistant | 208 W Casablanca Ave, 100, Cannon Afb, NM 88103-5009 | 2008-11-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346747151 | Isabella Wolak | Pharmacist | 224 D L Ingram Blvd, Cannon Afb, NM 88103 | 2018-04-09 |
| 1225480544 | Stacey Tatro | Dentist | 224 West D.l. Ingram Ave., Bldg 1408, Cannon Afb, NM 88103 | 2016-07-11 |
| 1871965673 | Chad Bryan Carter | Dentist | 224 W Dl Ingram Ave, Sgpd/dental Clinic, Cannon Air Force Base, NM 88103 | 2015-10-20 |
| 1740660836 | Terah Clifford | Dental Hygienist | 224 W Dl Ingram Blvd, Bldg 1408 Dental Clinic, Cannon Afb, NM 88103 | 2015-06-03 |
| 1528452208 | Taylor Bottari | Physician Assistant | 208 W Dl Ingram, Cannon Afb, NM 88103 | 2015-03-20 |
| 1588071328 | Gretchen Evelynn Szymanski | Nurse Practitioner | Cannon Afb, 224 W D.l. Ingram Blvd, Cannon Afb, NM 88103 | 2014-07-14 |
| 1396155206 | Jennifer Brynn Bendokas | Physician Assistant | 224 West Dl Ingram Avenue, Cannon Afb, NM 88103 | 2014-04-30 |
| 1366889487 | Jeremy Michael Strohmayer | General Practice | 511 Chindt Blvd Building 300, 27soss/osm, Cannon Afb, NM 88103 | 2013-05-30 |
| 1356622401 | Matthew John Nielsen | Dentist | 224 W D.l. Ingram, Bld. 1408, Cannon Afb, NM 88103 | 2011-09-02 |
| 1689965485 | Bryan Wade Sixkiller | Optometrist | 27th Somdg, 208 W. Casa Blanca Ave., Apo, AA 88103 | 2011-04-27 |
| Find all providers in zip 88103 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748692 | Patrick James Scollon | Military Health Care Provider | 104 W D. L. Ingram Ave, Cannon Afb, Nm 88101, Cannon Afb, NM 88101 | 2020-04-14 |
| 1598909012 | Martin Oleen Jensen | Military Health Care Provider | 119 E Arcadia Ave Bldg 622, 27 Special Operations Support Sqdn/osm, Cannon Afb, NM 88103-5112 | 2009-04-28 |
| 1053554204 | Jillian Marie Beausoleil | Military Health Care Provider | 511 N Torch Blvd Rm 102b, Cannon Afb, NM 88103-5109 | 2009-04-16 |
| 1497067839 | Ray Leroy Schatz IIi | Military Health Care Provider | 511 N Torch Blvd, Cannon Afb, NM 88103-5109 | 2010-07-13 |
| 1083844054 | Lindsay Vincent | Military Health Care Provider | 208 W Casablanca Ave, 27 Somdg, Cannon Afb, NM 88103-5009 | 2009-07-23 |
| 1497999684 | Francisco S Deguzman | Military Health Care Provider | 208 W Casablanca Ave Bldg 1400, 27 Somdg - Osm, Cannon Afb, NM 88103-5009 | 2009-05-01 |
| 1639313125 | Andrew Springstead | Military Health Care Provider | 208 W Casablanca Ave, 27somdg, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| 1366686842 | Steven Brandon Yates | Military Health Care Provider | 208 W Casablanca Ave, Cannon Afb, NM 88103-5009 | 2009-04-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801496625 | Stephen Kreidler | Military Health Care Provider | 5453 Roosevelt Loop Ne, Rio Rancho, NM 87144-5218 | 2020-10-30 |
| 1144797556 | William Murphy Whittle | Military Health Care Provider | 2000 Hallum St, Clovis, NM 88101-8684 | 2018-10-24 |
| 1265983068 | Yurikoaokio Motomochi Livas | Military Health Care Provider | 209 Wilmington Cir, Clovis, NM 88101-9382 | 2016-10-18 |
| 1245614544 | Rowland Coyle | Military Health Care Provider | 701 Stephen Moody Rd, Albuquerque, NM 87117 | 2015-07-16 |
| 1972939585 | Eugene Navarro Tabita | Military Health Care Provider | 4050a Greenhouse Pl Se, Albuquerque, NM 87116-3008 | 2013-09-16 |
| 1043553217 | Amanda Colyer | Military Health Care Provider | 2050 2nd St Se # A, Albuquerque, NM 87117-5522 | 2013-04-05 |
| 1831438357 | John Frederick Rinaldi | Military Health Care Provider | 3500 Adenmore Ct, Apt C, Clovis, NM 88101 | 2013-02-04 |
| 1003176389 | Ricky Franco Vela | Military Health Care Provider | 8101a W Sandia Cir Se, Albuquerque, NM 87116-5501 | 2012-05-21 |
| 1740583350 | Norma P Grandberry | Military Health Care Provider | 1501 Westchester St, Clovis, NM 88101-4638 | 2010-12-21 |
| 1609186139 | Jeramy Byrd | Military Health Care Provider | 9410 A Vermont Court, Clovis, NM 88101 | 2010-10-18 |
| Find all providers with the same taxonomy | ||||
| City | CANNON AFB |
| Zip Code | 88103 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.