Healthcare Provider Details

I. General information

NPI: 1114509098
Provider Name (Legal Business Name): EVELYN ENIT INGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 4TH ST SW # 114B
MASON CITY IA
50401-1612
US

IV. Provider business mailing address

100 4TH ST SW APT 306
MASON CITY IA
50401-3858
US

V. Phone/Fax

Practice location:
  • Phone: 641-428-6000
  • Fax:
Mailing address:
  • Phone: 917-215-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1114509098
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: