Provider Demographics
NPI:1679740740
Name:EVANS, ALISON MCCLELLAN (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:ALISON
Middle Name:MCCLELLAN
Last Name:EVANS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:ALISON
Other - Middle Name:EVANS
Other - Last Name:FRAGALE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:30 BROOKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:LEONARDO
Mailing Address - State:NJ
Mailing Address - Zip Code:07737-1701
Mailing Address - Country:US
Mailing Address - Phone:646-345-3424
Mailing Address - Fax:201-735-0076
Practice Address - Street 1:740 ROUTE 1 N
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2652
Practice Address - Country:US
Practice Address - Phone:732-726-0011
Practice Address - Fax:732-726-0030
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00158700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily