Provider Demographics
NPI:1396031449
Name:BROWN-MUTLU, EVELYN CHRISTINE
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:CHRISTINE
Last Name:BROWN-MUTLU
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 1:1750 WEST MAIN ST APT S3
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901
Mailing Address - Country:US
Mailing Address - Phone:631-885-6049
Mailing Address - Fax:
Practice Address - Street 1:1750 W MAIN ST APT S3
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3147
Practice Address - Country:US
Practice Address - Phone:631-885-6049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285661164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse