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NPI Code Detail

MEDICARE: EVOLVING EHEALTH LLC

MEDICARE: EVOLVING EHEALTH LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1548882343
Entity Type Code : Organization
Provider Name (Legal Business Name) : EVOLVING EHEALTH LLC
Provider Business Mailing Address
First Line : 1309 COFFEEN AVE STE 1200
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number :
Fax Number : 916-244-3882
Provider Business Practice Location Address
First Line : 1309 COFFEEN AVE STE 1200
Second Line :
City : SHERIDAN
State : WY
Zip : 82801-5777
Country : US
Telephone Number : 307-683-0983
Fax Number : 916-244-3882
Authorized Official
Title or Position : NURSE PRACTITIONER
Name : JACINTA WANGUI
Credential : ARNP, DNP, FNP-C
Telephone Number : 319-768-5858
Provider Enumeration Date : 05/14/2020
Last Update Date : 05/14/2020

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Directions to “EVOLVING EHEALTH LLC ” Practice Location

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