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General NPI Number Information
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NPI Number | 1336423631
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Entity Type | Individual
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Provider Name | ANGELA MARY EVANS CRNP
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Gender | Female
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Dates
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Enumeration Date | 10/05/2011
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | 301 LAKE STREET MISERICORDIA UNIVERSITY'S HEALTH & WELLNESS CENTER
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City | DALLAS
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State | PA
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Zip | 18612
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Country | US
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Telephone | 570-674-6276
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Fax |
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Provider Business Mailing Address
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Address Line | 396 STATE ROUTE 415
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City | NOXEN
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State | PA
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Zip | 18636
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Country | US
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Telephone | 570-639-1105
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | SP011624
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License Number State | PA
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