Healthcare Provider Details

I. General information

NPI: 1427551605
Provider Name (Legal Business Name): EVGENIA KHEMLIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 HIGH STREET SUITE 101
NORTH ANDOVER MA
01845-5201
US

IV. Provider business mailing address

47 HIGH STREET SUITE 101
NORTH ANDOVER MA
01845-5201
US

V. Phone/Fax

Practice location:
  • Phone: 312-637-9861
  • Fax: 770-573-9513
Mailing address:
  • Phone: 312-637-9861
  • Fax: 770-573-9513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2307075
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: