Healthcare Provider Details

I. General information

NPI: 1922056167
Provider Name (Legal Business Name): RACHAEL BLACKBURN EVANS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N WARREN ST
TRENTON NJ
08618-4741
US

IV. Provider business mailing address

321 N WARREN ST
TRENTON NJ
08618-4741
US

V. Phone/Fax

Practice location:
  • Phone: 609-731-9857
  • Fax: 609-695-3532
Mailing address:
  • Phone: 609-731-9857
  • Fax: 609-695-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08892600
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: