Healthcare Provider Details

I. General information

NPI: 1134041569
Provider Name (Legal Business Name): EMILIENNE MARCELIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NORTHEAST HEALTH SERVICES LLC 8 NORTH MAIN STREETBRONSON BUILDING, 5TH FLOOR
ATTLEBORO MA
02703
US

IV. Provider business mailing address

198 BROOK ST
REHOBOTH MA
02769-1741
US

V. Phone/Fax

Practice location:
  • Phone: 508-794-8711
  • Fax:
Mailing address:
  • Phone: 774-467-7951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2359332
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: