Provider Demographics
NPI:1831465285
Name:CONNOR, EVELYN JENITA (RN)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:JENITA
Last Name:CONNOR
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 1:21310 92ND AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1110
Mailing Address - Country:US
Mailing Address - Phone:718-776-0913
Mailing Address - Fax:718-264-1246
Practice Address - Street 1:21310 92ND AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1110
Practice Address - Country:US
Practice Address - Phone:718-776-0913
Practice Address - Fax:718-264-1246
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY361975-1163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool