Provider Demographics
NPI:1861217614
Name:EVANOIKA, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:EVANOIKA
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 1:1200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5220
Mailing Address - Country:US
Mailing Address - Phone:607-757-2188
Mailing Address - Fax:607-757-2176
Practice Address - Street 1:1200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5220
Practice Address - Country:US
Practice Address - Phone:607-757-2188
Practice Address - Fax:607-757-2176
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY777273163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool