Healthcare Provider Details

I. General information

NPI: 1508500125
Provider Name (Legal Business Name): EVAN DOLAN COLVIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 CHARLES ROLLINS RD STE 201
HENDERSON NC
27536-2882
US

IV. Provider business mailing address

13605 HEATHWOOD CT
RALEIGH NC
27615-1620
US

V. Phone/Fax

Practice location:
  • Phone: 252-438-4143
  • Fax:
Mailing address:
  • Phone: 205-873-4051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-184916
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberCOLV-9JJM3
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: