Healthcare Provider Details

I. General information

NPI: 1629622584
Provider Name (Legal Business Name): EVAN SILVERLAND PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 E DUBLIN GRANVILLE RD
WORTHINGTON OH
43085-3192
US

IV. Provider business mailing address

87 WARREN ST
COLUMBUS OH
43215-1566
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-7837
  • Fax: 614-515-5779
Mailing address:
  • Phone: 248-318-9132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number025433
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number448833
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: