Provider Demographics
NPI:1780861427
Name:SOIRE, ELLEN KEMUNTO MOCHACHE (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:KEMUNTO MOCHACHE
Last Name:SOIRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:124 SLEEPY HOLLOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5838
Mailing Address - Country:US
Mailing Address - Phone:302-449-3030
Mailing Address - Fax:302-449-3040
Practice Address - Street 1:124 SLEEPY HOLLOW DR STE 203
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-3030
Practice Address - Fax:302-449-3040
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-24
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 17815363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN 659134OtherREGISTERED NURSE LICENSE
CANP 17815OtherNURSE PRACTITIONER LICENS