Healthcare Provider Details

I. General information

NPI: 1548601693
Provider Name (Legal Business Name): ELISE ANNE EVANS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 HOSPITAL DRIVE SUITE 200
BATAVIA OH
45103
US

IV. Provider business mailing address

2055 HOSPITAL DRIVE SUITE 200
BATAVIA OH
45103
US

V. Phone/Fax

Practice location:
  • Phone: 513-735-1701
  • Fax: 513-735-8995
Mailing address:
  • Phone: 513-735-1701
  • Fax: 513-735-8995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP14837
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN.CNP.14837
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: