Healthcare Provider Details

I. General information

NPI: 1649298498
Provider Name (Legal Business Name): CANCER CARE FOR WOMEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

694 GOOD DRIVE SUITE 205
LANCASTER PA
17604
US

IV. Provider business mailing address

694 GOOD DRIVE SUITE 205
LANCASTER PA
17604
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-3190
  • Fax: 717-544-3189
Mailing address:
  • Phone: 717-544-3190
  • Fax: 717-544-3189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JACQUELINE EVANS
Title or Position: PRESIDENT
Credential: DO
Phone: 717-544-3190