Provider Demographics
NPI:1659680866
Name:EVANS, KATHLEENANNE (RN, BSED, LMT)
Entity Type:Individual
Prefix:MS
First Name:KATHLEENANNE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, BSED, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 576
Mailing Address - Street 2:9552 RTE 408 SOUTH
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-0576
Mailing Address - Country:US
Mailing Address - Phone:585-468-5570
Mailing Address - Fax:
Practice Address - Street 1:9552 RTE 408 SOUTH
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-0576
Practice Address - Country:US
Practice Address - Phone:585-468-5570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271796163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse