Healthcare Provider Details

I. General information

NPI: 1427268689
Provider Name (Legal Business Name): EVELYN LOUISE SILK NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVELYN LOUISE MCNITT NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 S VINE ST SUITE A
FALLBROOK CA
92028-2925
US

IV. Provider business mailing address

1168 WALES PL
CARDIFF BY THE SEA CA
92007-1512
US

V. Phone/Fax

Practice location:
  • Phone: 760-723-2313
  • Fax: 760-723-0333
Mailing address:
  • Phone: 760-943-0011
  • Fax: 951-695-0133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNP2982
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: