Provider Demographics
NPI:1659552974
Name:EVANS, KIRSTEN LEAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:LEAH
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 BARTLETT ST.
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359
Mailing Address - Country:US
Mailing Address - Phone:617-470-0769
Mailing Address - Fax:
Practice Address - Street 1:7 BARTLETT ST
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359
Practice Address - Country:US
Practice Address - Phone:617-470-0769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA262917163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0713805OtherMASSHEALTH