Provider Demographics
NPI:1639156904
Name:EVANS, CHARLOTTE J (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:J
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CHARLOTTS
Other - Middle Name:J
Other - Last Name:CUMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:6211 WATERFORD BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-2869
Mailing Address - Country:US
Mailing Address - Phone:812-465-6202
Mailing Address - Fax:812-465-3621
Practice Address - Street 1:6211 WATERFORD BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-2869
Practice Address - Country:US
Practice Address - Phone:812-465-6202
Practice Address - Fax:812-465-3621
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000408A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200171930Medicaid
IN000000343511OtherBCBS
04367929410OtherDONLEY & CO
7483165OtherAETNA
P00179584OtherRAILROAD MEDICARE
04367929410OtherDONLEY & CO
IN229080BMedicare PIN