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Individual
MARY DESALLE
Active
Individual
MARY DESALLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
GNP
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
AP081312
ME
363LG0600X
Gerontology Nurse Practitioner
R026628
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100072
BCBS
ME
05
—
1427034396
—
ME
01
—
2735452
AETNA
ME
01
—
304310001
CIGNA
ME
01
—
500017332
RR MEDICARE
ME
01
—
MN5036
HPHC
ME
Enumeration date
12/21/2005
Last updated
02/05/2013
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