Healthcare Provider Details

I. General information

NPI: 1619697364
Provider Name (Legal Business Name): LILIAS EVANS DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 RIVERSIDE DR
NEW YORK NY
10032-1007
US

IV. Provider business mailing address

533 PARK PL APT 3B
BROOKLYN NY
11238-3099
US

V. Phone/Fax

Practice location:
  • Phone: 646-774-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number404194
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: