Provider Demographics
NPI:1689097032
Name:DUVIVIER, GAELLE AMATALIE (CNM, WHNP)
Entity Type:Individual
Prefix:
First Name:GAELLE
Middle Name:AMATALIE
Last Name:DUVIVIER
Suffix:
Gender:F
Credentials:CNM, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4166A WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10466-3020
Mailing Address - Country:US
Mailing Address - Phone:718-696-6262
Mailing Address - Fax:718-696-6260
Practice Address - Street 1:4166A WHITE PLAINS RD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10466-3020
Practice Address - Country:US
Practice Address - Phone:718-696-6262
Practice Address - Fax:718-696-6260
Is Sole Proprietor?:No
Enumeration Date:2014-01-21
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY679876163W00000X
NY421431363LW0102X
NY002021176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163W00000XNursing Service ProvidersRegistered Nurse
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health