Provider Demographics
NPI:1407217227
Name:DESPIERRE, EMILY (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DESPIERRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 ELM ST
Mailing Address - Street 2:SUITE 202B
Mailing Address - City:MONROE
Mailing Address - State:CT
Mailing Address - Zip Code:06468-2280
Mailing Address - Country:US
Mailing Address - Phone:203-880-5335
Mailing Address - Fax:
Practice Address - Street 1:324 ELM ST
Practice Address - Street 2:SUITE 202B
Practice Address - City:MONROE
Practice Address - State:CT
Practice Address - Zip Code:06468-2280
Practice Address - Country:US
Practice Address - Phone:203-880-5335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006490363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health