Provider Demographics
NPI:1942279849
Name:EVANS, PHYLLIS ANITA (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:ANITA
Last Name:EVANS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 W 83RD PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60652-3904
Mailing Address - Country:US
Mailing Address - Phone:773-776-6236
Mailing Address - Fax:
Practice Address - Street 1:JESSE BROWN VA MEDICAL CENTER
Practice Address - Street 2:820 SOUTH DAMEN AVENUE
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-7592
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health