Provider Demographics
NPI:1427228428
Name:EVANS, MARK (RN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:198 UPPER POWDERLY ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-2777
Mailing Address - Country:US
Mailing Address - Phone:570-282-3464
Mailing Address - Fax:
Practice Address - Street 1:198 UPPER POWDERLY ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-2777
Practice Address - Country:US
Practice Address - Phone:570-282-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN585642163W00000X
NY22 591919163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse