Provider Demographics
NPI:1417412545
Name:EVANS, SARAH NICOLLE (RN,BSN)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:NICOLLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:NICOLLE
Other - Last Name:HENLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN,BSN
Mailing Address - Street 1:395 ECHO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-1933
Mailing Address - Country:US
Mailing Address - Phone:609-425-5986
Mailing Address - Fax:
Practice Address - Street 1:17 BANK AVE
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2703
Practice Address - Country:US
Practice Address - Phone:631-265-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-03
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY757310163WP0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP0200XNursing Service ProvidersRegistered NursePediatrics