Provider Demographics
NPI:1437745445
Name:EVANS, EMILY M (AGPCNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:MRS
Other - First Name:ERICA
Other - Middle Name:M
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AGPCNP-BC
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:607-873-1244
Practice Address - Street 1:300 HOFFMAN ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-2263
Practice Address - Country:US
Practice Address - Phone:607-734-4110
Practice Address - Fax:607-734-0344
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310045363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103864741Medicaid
NY06344976Medicaid