Provider Demographics
NPI:1578880597
Name:HAUGHTON, EVELYN ELAINE (FNP)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:ELAINE
Last Name:HAUGHTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6735 112TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2349
Mailing Address - Country:US
Mailing Address - Phone:718-263-0740
Mailing Address - Fax:718-263-9834
Practice Address - Street 1:6735 112TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2349
Practice Address - Country:US
Practice Address - Phone:718-263-0740
Practice Address - Fax:718-263-9834
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY335171-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily