Healthcare Provider Details

I. General information

NPI: 1740772904
Provider Name (Legal Business Name): EMANIE ELYSEE DORIVAL CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMANIE ELYSEE

II. Dates (important events)

Enumeration Date: 06/04/2018
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 MIDDLEFORD RD STE 501
SEAFORD DE
19973-3664
US

IV. Provider business mailing address

1350 MIDDLEFORD RD STE 501
SEAFORD DE
19973-3664
US

V. Phone/Fax

Practice location:
  • Phone: 302-444-0190
  • Fax: 302-990-1137
Mailing address:
  • Phone: 302-444-0190
  • Fax: 302-990-1137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberLG-0001282
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAC003919
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License NumberLG0001282
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberLG0001282
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAC003919
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: