MEDICARE: GWENDOLYN DAWN EVANS NP

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
1	363LF0000X	Family Nurse Practitioner	0024192192	VA
2	363LF0000X	Family Nurse Practitioner	4704352470NSA210NL	MI

General Provider Information

NPI Number	:	1396413936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN DAWN EVANS NP

Provider Business Mailing Address
First Line	:	PO BOX 388
Second Line	:
City	:	FISHERSVILLE
State	:	VA
Zip	:	22939-0388
Country	:	US
Telephone Number	:	540-332-5168
Fax Number	:	540-332-5875

Provider Business Practice Location Address
First Line	:	201 LEW DEWITT BLVD STE A
Second Line	:
City	:	WAYNESBORO
State	:	VA
Zip	:	22980-1663
Country	:	US
Telephone Number	:	540-245-7940
Fax Number	:	540-245-7941

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2021
Last Update Date	:	05/11/2026

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