Provider Demographics
NPI:1609084441
Name:EVANS, VICTORIA S (CNM)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:S
Last Name:EVANS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04843-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22 WHITE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-2978
Practice Address - Country:US
Practice Address - Phone:207-592-3114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER026098367A00000X
CT000023367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife