Healthcare Provider Details

I. General information

NPI: 1730626615
Provider Name (Legal Business Name): GENEVIEVE EVANS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 04/12/2024
Certification Date: 04/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 W 145TH ST
NEW YORK NY
10031-5101
US

IV. Provider business mailing address

11213 AVALON GATES
TRUMBULL CT
06611-5841
US

V. Phone/Fax

Practice location:
  • Phone: 646-400-4625
  • Fax:
Mailing address:
  • Phone: 646-400-4625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number786308
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number261498
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: