Healthcare Provider Details

I. General information

NPI: 1790507333
Provider Name (Legal Business Name): ALEXA JADE EVANS WHNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2024
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 FRANKFORD AVE
PHILADELPHIA PA
19124-3602
US

IV. Provider business mailing address

31 OAKWOOD DR
ALBANY NY
12205-1709
US

V. Phone/Fax

Practice location:
  • Phone: 888-296-4742
  • Fax:
Mailing address:
  • Phone: 518-253-2487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberSP031010
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: