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General NPI Number Information
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NPI Number | 1790507333
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Entity Type | Individual
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Provider Name | ALEXA JADE EVANS WHNP-BC
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Gender |
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Dates
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Enumeration Date | 10/25/2024
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 4500 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19124-3602
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Country | US
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Telephone | 888-296-4742
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Fax |
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Provider Business Mailing Address
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Address Line | 31 OAKWOOD DR
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City | ALBANY
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State | NY
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Zip | 12205-1709
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Country | US
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Telephone | 518-253-2487
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | SP031010
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License Number State | PA
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