Jose Marie Cornelio Derla, RN
Individual provider Active NPI Psychiatric/Mental Health Registered Nurse · Zion, IL
NPI 1386965754 · NPPES record last updated Jun 18, 2010
Key facts
- NPI
- 1386965754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Registered Nurse 163WP0808X
- License
- 041.359360 (IL)
- Practice address
- 2400 Michael Ave
Zion, IL 60099-9224 - Phone
- (224) 353-9424
- NPI assigned
- Jun 18, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041.359360 | IL | MD | Psychiatric/Mental Health Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Registered Nurse | 163WP0808X | 041.359360 | IL | Yes |
Addresses
Primary practice location
2400 Michael Ave
Zion, IL 60099-9224
Mailing address
2400 Michael Ave
Zion, IL 60099-9224
Phone (224) 353-9424
Other providers in Zion, IL
- Tammy M. Dechant-Heard
- Rebecca Degraw
- Delain Health Group
- Elisa A Demet
- Lisa Albino Dennis
- Leah Derla
- Monica Donald
- Charles Waltz Dowdy V
- Neil Curtis Dunavin
- Wallis Olivia Edwards
All providers in Zion, IL · Psychiatric/Mental Health Registered Nurse in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 18, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.