Provider Demographics
NPI:1477072494
Name:NILES, EVELYN DOROTHY
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:DOROTHY
Last Name:NILES
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:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-0527
Mailing Address - Country:US
Mailing Address - Phone:207-249-8998
Mailing Address - Fax:
Practice Address - Street 1:777 STILLWATER AVE
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2200
Practice Address - Country:US
Practice Address - Phone:207-249-8998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-11
Last Update Date:2017-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility