Provider Demographics
NPI:1134759418
Name:STEIN, EVELYN VIRGINIA
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:VIRGINIA
Last Name:STEIN
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 1:3 WAKE ROBIN RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:RI
Mailing Address - Zip Code:02865-4208
Mailing Address - Country:US
Mailing Address - Phone:401-475-9140
Mailing Address - Fax:
Practice Address - Street 1:3 WAKE ROBIN RD STE 5
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865-4208
Practice Address - Country:US
Practice Address - Phone:401-475-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-25
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant