Provider Demographics
NPI:1306000336
Name:DOWNEY, EVETTE M
Entity Type:Individual
Prefix:MRS
First Name:EVETTE
Middle Name:M
Last Name:DOWNEY
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 1:45 GREAT ROCK DR
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-1850
Mailing Address - Country:US
Mailing Address - Phone:631-929-0560
Mailing Address - Fax:
Practice Address - Street 1:45 GREAT ROCK DR
Practice Address - Street 2:
Practice Address - City:WADING RIVER
Practice Address - State:NY
Practice Address - Zip Code:11792-1850
Practice Address - Country:US
Practice Address - Phone:631-929-0560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY236618-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse