Healthcare Provider Details

I. General information

NPI: 1851378871
Provider Name (Legal Business Name): JACQUELINE ANN EVANS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 NOLL DR
LANCASTER PA
17603
US

IV. Provider business mailing address

409 S 2ND ST STE 2F
HARRISBURG PA
17104-1612
US

V. Phone/Fax

Practice location:
  • Phone: 717-874-4297
  • Fax: 717-874-4298
Mailing address:
  • Phone: 717-874-4297
  • Fax: 717-874-4298

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberOS008644L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: