Nicole Marie Desiderati, RN PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201350103NP Issued in OR

Practice address

10011 SE Division St
Suite 203
Portland, OR 97266-1351

Phone

(503) 255-2343

Fax

(503) 255-2344

NPI assigned

Jan 23, 2008

Last updated

Dec 17, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Northwest ADHD Treatment Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Portland, OR
  • NPI 1225459548
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1201046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418774400000",
    "number": "1558548370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 16308",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972920308",
            "telephone_number": "503-255-2343",
            "fax_number": "503-255-2344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10011 SE DIVISION ST",
            "address_2": "SUITE 203",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972661351",
            "telephone_number": "503-255-2343",
            "fax_number": "503-255-2344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESIDERATI",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "RN PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-23",
        "last_updated": "2014-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201350103NP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "096511",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "22959",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Micah Deshazo
• Litany Deshincoe
• Alex Deshler, CADCI
• Vivek Raghvendra Deshmukh, MD
• Desiderata Counseling, LLC
• Gail Desimone
• June M Desimone, MD
• Kori Desimone
• Sadee Desir
• Linda L Desitter, MD

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.