Provider Demographics
NPI:1700295805
Name:BUTEAU, EMMANUELLE
Entity Type:Individual
Prefix:
First Name:EMMANUELLE
Middle Name:
Last Name:BUTEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EMMANUELLE
Other - Middle Name:ANDREE
Other - Last Name:NAPOLEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 E 30TH ST APT 4W
Mailing Address - Street 2:350 EAST 30 STREET APT 4W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8389
Mailing Address - Country:US
Mailing Address - Phone:914-564-2909
Mailing Address - Fax:
Practice Address - Street 1:350 E 30TH ST APT 4W
Practice Address - Street 2:SAME AS ABOVE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8389
Practice Address - Country:US
Practice Address - Phone:914-564-2909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230659-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse