Desalle, Mary

Desalle, Mary is an individual health care provider with primary practice located at 655 Main St , Saco ME 04072-1543. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Gerontology, which is considered as her primary health care specialty. Desalle, Mary can be contacted via phone (207) 602-3571.

Contact Information

Primary practice address
655 Main St Saco ME 04072-1543
Phone: (207) 602-3571
Fax: (207) 602-3573
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X R026628 Maine
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X AP081312 Maine

Profile Details

NPI number 1427034396
LBN Legal business name Desalle, Mary
Credentials Gerontological Nurse Practitioner (GNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 21st, 2005
Last updated Feb 5th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427034396 NPPES
Maine Other 100072 BCBS
Maine Other 304310001 BCBS
Maine MEDICAID 1427034396 BCBS
Maine Other 2735452 BCBS
Maine Other MN5036 BCBS
Maine Other 500017332 BCBS

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