Provider Demographics
NPI:1407217227
Name:DESPIERRE, EMILY (NP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:DESPIERRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CENTERPOINT DR STE 215
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-7568
Mailing Address - Country:US
Mailing Address - Phone:774-388-7850
Mailing Address - Fax:479-339-0771
Practice Address - Street 1:30 BOSTON RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3543
Practice Address - Country:US
Practice Address - Phone:774-388-7850
Practice Address - Fax:479-339-0771
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006490363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health