Provider Demographics
NPI:1730394867
Name:EVANS, ANNE ELIZA
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:ELIZA
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 PLEASANT ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-2952
Mailing Address - Country:US
Mailing Address - Phone:603-224-2353
Mailing Address - Fax:603-226-0727
Practice Address - Street 1:194 PLEASANT ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-2952
Practice Address - Country:US
Practice Address - Phone:603-224-2353
Practice Address - Fax:603-226-0727
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHA78231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30001976Medicaid
NH23084YMedicare UPIN
NHRE1110Medicare ID - Type Unspecified