Healthcare Provider Details

I. General information

NPI: 1194071514
Provider Name (Legal Business Name): SNEHA RAO EVANS RN/NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

IV. Provider business mailing address

1601 WASHINGTON ST
BOSTON MA
02118-1951
US

V. Phone/Fax

Practice location:
  • Phone: 617-425-2000
  • Fax: 617-425-2002
Mailing address:
  • Phone: 617-425-2000
  • Fax: 617-425-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberRN2270557
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN2270557
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: