Provider Demographics
NPI:1639165004
Name:ASANTE, EVELYN (NP)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:ASANTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:486 SILVER SPRING ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-1556
Mailing Address - Country:US
Mailing Address - Phone:401-454-0690
Mailing Address - Fax:401-454-4281
Practice Address - Street 1:486 SILVER SPRING ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-1556
Practice Address - Country:US
Practice Address - Phone:401-454-0690
Practice Address - Fax:401-454-4281
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINP36927363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7058016Medicaid
RI709004044OtherMEDICARE GROUP
RI412888OtherBLUE CHIP
RI29913-0OtherBCBS OF RI
RI050483739OtherTIN #
RI709004044OtherMEDICARE GROUP
RI007058016Medicare ID - Type Unspecified