Provider Demographics
NPI:1548601693
Name:EVANS, ELISE ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:ANNE
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103
Mailing Address - Country:US
Mailing Address - Phone:513-735-1701
Mailing Address - Fax:513-735-8995
Practice Address - Street 1:2055 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103
Practice Address - Country:US
Practice Address - Phone:513-735-1701
Practice Address - Fax:513-735-8995
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP14837363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care