Provider Demographics
NPI:1588430227
Name:PAUL, EMMALYN NOELLE (CLS)
Entity type:Individual
Prefix:
First Name:EMMALYN
Middle Name:NOELLE
Last Name:PAUL
Suffix:
Gender:F
Credentials:CLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1189 COUNTY ROAD 1000 N
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:IL
Mailing Address - Zip Code:61530-9346
Mailing Address - Country:US
Mailing Address - Phone:309-210-3476
Mailing Address - Fax:
Practice Address - Street 1:1189 COUNTY ROAD 1000 N
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:IL
Practice Address - Zip Code:61530-9346
Practice Address - Country:US
Practice Address - Phone:309-210-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN