Provider Demographics
NPI:1881212652
Name:MONAHAN, EVAN NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:EVAN
Middle Name:NICOLE
Last Name:MONAHAN
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 1:12115 E 21ST ST N STE 107
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3571
Mailing Address - Country:US
Mailing Address - Phone:620-966-7386
Mailing Address - Fax:
Practice Address - Street 1:910 CORONADO DR
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-2258
Practice Address - Country:US
Practice Address - Phone:620-259-7022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79515-031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily