Provider Demographics
NPI:1740772904
Name:DORIVAL, EMANIE ELYSEE (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:EMANIE
Middle Name:ELYSEE
Last Name:DORIVAL
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:EMANIE
Other - Middle Name:
Other - Last Name:ELYSEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 MIDWAY DR STE 3
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19952-2448
Mailing Address - Country:US
Mailing Address - Phone:800-818-8680
Mailing Address - Fax:800-818-8680
Practice Address - Street 1:1000 MIDWAY DR STE 3
Practice Address - Street 2:
Practice Address - City:HARRINGTON
Practice Address - State:DE
Practice Address - Zip Code:19952
Practice Address - Country:US
Practice Address - Phone:800-818-8680
Practice Address - Fax:800-818-8680
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0001282363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner