Provider Demographics
NPI:1336423631
Name:EVANS, ANGELA MARY (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARY
Last Name:EVANS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 STATE ROUTE 415
Mailing Address - Street 2:
Mailing Address - City:NOXEN
Mailing Address - State:PA
Mailing Address - Zip Code:18636
Mailing Address - Country:US
Mailing Address - Phone:570-639-1105
Mailing Address - Fax:
Practice Address - Street 1:301 LAKE STREET
Practice Address - Street 2:MISERICORDIA UNIVERSITY'S HEALTH & WELLNESS CENTER
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612
Practice Address - Country:US
Practice Address - Phone:570-674-6276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily