Healthcare Provider Details

I. General information

NPI: 1245438670
Provider Name (Legal Business Name): NANCY EVANS N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2007
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MITCHELL AVE.
BINGHAMTON NY
13903
US

IV. Provider business mailing address

72 STEWART RD
CONKLIN NY
13748-1611
US

V. Phone/Fax

Practice location:
  • Phone: 607-723-1676
  • Fax: 607-772-6304
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number467097-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: