Individual
MS. NICOLE MARIE DESIDERATI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN PMHNP-BC
Contact information
Practice address
10011 SE DIVISION ST, SUITE 203, PORTLAND, OR 97266-1351
(503) 255-2343
(503) 255-2344
Mailing address
PO BOX 16308, PORTLAND, OR 97292-0308
(503) 255-2343
(503) 255-2344
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201350103NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
Enumeration date
01/23/2008
Last updated
12/17/2014
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