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General NPI Number Information
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NPI Number | 1891795456
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Entity Type | Individual
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Provider Name | CARIE A EVANS WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 07/26/2005
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 270 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2004
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Country | US
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Telephone | 618-498-4166
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Fax | 618-639-7997
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Provider Business Mailing Address
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Address Line | 390 MAPLE SUMMIT RD
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City | JERSEYVILLE
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State | IL
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Zip | 62052-2000
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Country | US
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Telephone | 184-987-5186
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Fax | 618-498-3052
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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 | 144185
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 209006351
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License Number State | IL
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