Healthcare Provider Details

I. General information

NPI: 1811537400
Provider Name (Legal Business Name): VICTORIA EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
HARRISON NY
10528-1140
US

IV. Provider business mailing address

72 WEST AVE APT B
DARIEN CT
06820-4407
US

V. Phone/Fax

Practice location:
  • Phone: 914-967-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number709292
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: