Provider Demographics
NPI:1598856445
Name:DAUTRUCHE, ELIENNE (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:ELIENNE
Middle Name:
Last Name:DAUTRUCHE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 ALYSSA DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ROYAL
Mailing Address - State:NJ
Mailing Address - Zip Code:08061-1071
Mailing Address - Country:US
Mailing Address - Phone:856-423-7900
Mailing Address - Fax:
Practice Address - Street 1:180 ALYSSA DR
Practice Address - Street 2:
Practice Address - City:MOUNT ROYAL
Practice Address - State:NJ
Practice Address - Zip Code:08061-1071
Practice Address - Country:US
Practice Address - Phone:856-423-7900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJHP0086200374U00000X, 376K00000X, 372500000X, 372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered374U00000XNursing Service Related ProvidersHome Health Aide
Not Answered376K00000XNursing Service Related ProvidersNurse's Aide
Not Answered372500000XNursing Service Related ProvidersChore Provider
Not Answered372600000XNursing Service Related ProvidersAdult Companion