Provider Demographics
NPI:1295262772
Name:ANDERSEN, EVELYN LAUREN (ARNP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LAUREN
Last Name:ANDERSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 WEST 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54902
Mailing Address - Country:US
Mailing Address - Phone:920-651-3600
Mailing Address - Fax:920-651-3605
Practice Address - Street 1:1259 WEST 20TH AVE
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54902
Practice Address - Country:US
Practice Address - Phone:920-651-3600
Practice Address - Fax:920-651-3605
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7801363L00000X
WI178788-30163WG0000X
WI7801-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily