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General NPI Number Information
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NPI Number | 1225755119
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Entity Type | Individual
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Provider Name | NDENE DERICK SALLE DNP, APRN, PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/21/2022
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Last Update Date | 03/03/2024
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Provider Practice Location Address
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Address Line | 10000 S WILMOT RD
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City | TUCSON
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State | AZ
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Zip | 85756-8699
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Country | US
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Telephone | 240-425-7240
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Fax |
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Provider Business Mailing Address
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Address Line | 9550 S VIA BANDERA
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City | VAIL
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State | AZ
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Zip | 85641-2167
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Country | US
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Telephone | 240-425-7240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 256335
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License Number State | AZ
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