Provider Demographics
NPI:1154052496
Name:EVILSIZOR, EMILY BETH (RN, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:BETH
Last Name:EVILSIZOR
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 S 46TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19139-4513
Mailing Address - Country:US
Mailing Address - Phone:215-280-9752
Mailing Address - Fax:
Practice Address - Street 1:252 S 46TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-4513
Practice Address - Country:US
Practice Address - Phone:215-280-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA583761163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant