Organization
EPHPHATHA MEDICAL CARE SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EMANIE E DORIVAL CRNP (NURSE PRACTITIONER)
(925) 222-9572
Entity
Organization
Contact information
Practice address
23092 MEADOW WOOD CT UNIT 416, SEAFORD, DE 19973-7753
(925) 222-9572
Mailing address
23092 MEADOW WOOD CT UNIT 416, SEAFORD, DE 19973-7753
(925) 222-9572
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
07/30/2019
Last updated
09/26/2019
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