Provider Demographics
NPI:1104828953
Name:EVANS, ROSEANNE (FNP)
Entity Type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BRANDON AVE
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-2008
Mailing Address - Country:US
Mailing Address - Phone:252-823-8640
Mailing Address - Fax:
Practice Address - Street 1:201 W EDGECOMBE ST
Practice Address - Street 2:
Practice Address - City:MACCLESFIELD
Practice Address - State:NC
Practice Address - Zip Code:27852
Practice Address - Country:US
Practice Address - Phone:252-827-5231
Practice Address - Fax:252-827-5775
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200750363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2594827Medicare ID - Type Unspecified