Provider Demographics
NPI:1679017529
Name:EVANS, IRINA (MSN,FNP-BC)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSN,FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3556 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517-3992
Mailing Address - Country:US
Mailing Address - Phone:224-627-3611
Mailing Address - Fax:
Practice Address - Street 1:1775 DEMPSTER ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-2445
Practice Address - Fax:847-723-2470
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-12
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily