Provider Demographics
NPI:1477012029
Name:EVANS, THERESA MARGARET (APRN NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:MARGARET
Last Name:EVANS
Suffix:
Gender:F
Credentials:APRN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:1 EDMUNDSON PL STE 100
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4659
Practice Address - Country:US
Practice Address - Phone:717-322-4136
Practice Address - Fax:717-322-8129
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE112732363L00000X
IAA175030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner