Provider Demographics
NPI:1255357471
Name:EVANS, SHARENE (APRN)
Entity type:Individual
Prefix:
First Name:SHARENE
Middle Name:
Last Name:EVANS
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 1:1 MEDICAL CENTER DR
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-1000
Mailing Address - Country:US
Mailing Address - Phone:603-650-5125
Mailing Address - Fax:603-650-7483
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-1000
Practice Address - Country:US
Practice Address - Phone:603-650-5125
Practice Address - Fax:603-650-7483
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH037225-23-12363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30340712Medicaid
VT0NP2244Medicaid
VT0NP2244Medicaid
NH30340712Medicaid