Provider Demographics
NPI:1073811915
Name:DSOUZA, EMMANUEL P (CNP)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:P
Last Name:DSOUZA
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 S BREIEL BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45044-6701
Mailing Address - Country:US
Mailing Address - Phone:513-420-8195
Mailing Address - Fax:
Practice Address - Street 1:300 FOREST AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-4500
Practice Address - Country:US
Practice Address - Phone:937-535-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-02
Last Update Date:2021-08-18
Deactivation Date:2013-01-24
Deactivation Code:
Reactivation Date:2015-02-10
Provider Licenses
StateLicense IDTaxonomies
OHRN.314957163W00000X
OH17016- NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse