Provider Demographics
NPI:1891795456
Name:EVANS, CARIE A (WHNP-BC)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 MAPLE SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-2000
Mailing Address - Country:US
Mailing Address - Phone:618-498-8310
Mailing Address - Fax:618-498-8439
Practice Address - Street 1:270 MAPLE SUMMIT RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-2004
Practice Address - Country:US
Practice Address - Phone:618-498-2273
Practice Address - Fax:618-639-7997
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO144185363LW0102X
IL209006351363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1134163827OtherGNPI