Provider Demographics
NPI:1255473666
Name:LOUIS, EMMANISE I (FNP)
Entity type:Individual
Prefix:
First Name:EMMANISE
Middle Name:
Last Name:LOUIS
Suffix:I
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:EMMANISE
Other - Middle Name:
Other - Last Name:GREGOIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:88 COUTANT RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10919-3208
Mailing Address - Country:US
Mailing Address - Phone:845-893-9463
Mailing Address - Fax:845-767-5113
Practice Address - Street 1:15 E MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1924
Practice Address - Country:US
Practice Address - Phone:845-893-9463
Practice Address - Fax:845-767-5113
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332918-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02915864Medicaid