Provider Demographics
NPI:1730348400
Name:EVANS, BRENDA F (NP)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:F
Last Name:EVANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 PORTLAND AVE
Mailing Address - Street 2:RGH, ALLERGY, IMMUNOLOGY, RHEUMATOLOGY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621-3001
Mailing Address - Country:US
Mailing Address - Phone:585-922-9730
Mailing Address - Fax:585-586-8786
Practice Address - Street 1:1425 PORTLAND AVE
Practice Address - Street 2:RGH, ALLERGY IMMUNOLOGY RHEUMATOLOGY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-3001
Practice Address - Country:US
Practice Address - Phone:585-922-9730
Practice Address - Fax:585-586-8786
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF330305-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400003110Medicare PIN