Provider Demographics
NPI:1922490838
Name:EVANS, FATIMA
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 NORTH B 12PLACE
Mailing Address - Street 2:
Mailing Address - City:PROSPECTPARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07508
Mailing Address - Country:US
Mailing Address - Phone:862-668-8203
Mailing Address - Fax:
Practice Address - Street 1:232 NORTHB 12PLACE
Practice Address - Street 2:
Practice Address - City:PROSPECTPARK
Practice Address - State:NJ
Practice Address - Zip Code:07508
Practice Address - Country:US
Practice Address - Phone:862-668-8203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY321250164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse