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General NPI Number Information
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NPI Number | 1366001349
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Entity Type | Individual
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Provider Name | EVELYN DATU FNP
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Gender | Female
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 06/12/2019
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Provider Practice Location Address
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Address Line | 655 EUCLID AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2957
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Country | US
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Telephone | 619-470-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 2319 MAGNOLIA WAY
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City | NATIONAL CITY
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State | CA
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Zip | 91950-1974
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Country | US
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Telephone | 619-550-8526
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95008292
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN624984
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License Number State | CA
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