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NPI Code Detail

MEDICARE: EVANA DOUGLAS RN

MEDICARE: EVANA DOUGLAS RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN676603PA

General Provider Information

NPI Number : 1346197092
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVANA DOUGLAS RN
Provider Business Mailing Address
First Line : 2531 S 15TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19145-4610
Country : US
Telephone Number : 215-776-1542
Fax Number :
Provider Business Practice Location Address
First Line : 1144 LOCUST ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19107-6734
Country : US
Telephone Number : 215-351-5550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2026
Last Update Date : 03/12/2026

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