Provider Demographics
NPI:1689615700
Name:DUFFY, EVELYN (APRN)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:DUFFY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8819 QUINCY AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3419
Mailing Address - Country:US
Mailing Address - Phone:216-721-2177
Mailing Address - Fax:216-721-2375
Practice Address - Street 1:8819 QUINCY AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-3419
Practice Address - Country:US
Practice Address - Phone:216-721-2177
Practice Address - Fax:216-721-2375
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-06870363LA2200X
OH06870363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000541029OtherANTHEM #
OH751128OtherBUCKEYE #
OH421779OtherWELLCARE
OH5507634OtherAETNA #
OHP00445625OtherRAILROAD MEDICARE
OH000000226045OtherUNISON #
OH2003718Medicaid
OH421779OtherWELLCARE