Provider Demographics
NPI:1700127263
Name:DOUCETTE, EMILY ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ANN
Last Name:DOUCETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:ANN
Other - Last Name:DUPONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:27 CONGRESS ST STE 513
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5523
Mailing Address - Country:US
Mailing Address - Phone:978-744-8388
Mailing Address - Fax:
Practice Address - Street 1:302 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-282-8899
Practice Address - Fax:978-282-5599
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN271263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110128092AMedicaid