Provider Demographics
NPI:1588154363
Name:BOATENG, EVELYN (RN, FNP AANP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BOATENG
Suffix:
Gender:F
Credentials:RN, FNP AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 FARMINGTON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3990
Mailing Address - Country:US
Mailing Address - Phone:860-576-0514
Mailing Address - Fax:
Practice Address - Street 1:200 JOHN DOWNEY DR
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-2904
Practice Address - Country:US
Practice Address - Phone:203-435-7506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7551363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily