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General NPI Number Information
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NPI Number | 1245884048
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Entity Type | Organization
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Legal Business Name | EPHPHATHA MEDICAL CARE SERVICES LLC
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 23092 MEADOW WOOD CT UNIT 416
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City | SEAFORD
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State | DE
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Zip | 19973-7753
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Country | US
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Telephone | 925-222-9572
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Fax |
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Provider Business Mailing Address
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Address Line | 23092 MEADOW WOOD CT UNIT 416
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City | SEAFORD
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State | DE
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Zip | 19973-7753
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Country | US
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Telephone | 925-222-9572
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | EMANIE E DORIVAL
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Credential | CRNP
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Telephone | 925-222-9572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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