Provider Demographics
NPI:1730626615
Name:EVANS, GENEVIEVE (RN)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11213 AVALON GATES
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-5841
Mailing Address - Country:US
Mailing Address - Phone:646-400-4625
Mailing Address - Fax:
Practice Address - Street 1:507 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-5101
Practice Address - Country:US
Practice Address - Phone:646-400-4625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-30
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY786308163WA0400X
NY261498164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)