Provider Demographics
NPI:1609157007
Name:O'NEILL-BROWN, EVELYN A (PNP)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:A
Last Name:O'NEILL-BROWN
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 RANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2359
Mailing Address - Country:US
Mailing Address - Phone:718-829-6094
Mailing Address - Fax:
Practice Address - Street 1:3011 RANDALL AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2359
Practice Address - Country:US
Practice Address - Phone:718-829-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF382096-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF382096OtherNYS LICENSE