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NPI Code Detail

MEDICARE: MRS. CHARLOTTE J EVANS FNP

MEDICARE: MRS. CHARLOTTE J EVANS FNP
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 Practitioner71000408AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5P00179584OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000343511OTHERINBCBS
304367929410OTHERDONLEY & CO
47483165OTHERAETNA

General Provider Information

NPI Number : 1639156904
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CHARLOTTE J EVANS FNP
Provider Business Mailing Address
First Line : 6211 WATERFORD BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2869
Country : US
Telephone Number : 812-465-6202
Fax Number : 812-465-3621
Provider Business Practice Location Address
First Line : 6211 WATERFORD BLVD
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2869
Country : US
Telephone Number : 812-465-6202
Fax Number : 812-465-3621
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2005
Last Update Date : 05/14/2015

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