Healthcare Provider Details

I. General information

NPI: 1962394213
Provider Name (Legal Business Name): EMILIENNE DEWELE TRAORE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 COYLE AVE
CARMICHAEL CA
95608-0306
US

IV. Provider business mailing address

9774 JOEBAR CIR
ELK GROVE CA
95757-6255
US

V. Phone/Fax

Practice location:
  • Phone: 916-537-5365
  • Fax:
Mailing address:
  • Phone: 650-804-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number765458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: