# MARY DESALLE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1427034396
- **Gender:** F
- **Credential:** GNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LG0600X | Gerontology Nurse Practitioner | AP081312 | ME | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | R026628 | ME | — |

## Other

- **Enumeration date:** 12/21/2005
- **Last updated:** 02/05/2013

## 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 |