Provider Demographics
NPI:1720165582
Name:EVANS, BARBARA DUFFY (GNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:DUFFY
Last Name:EVANS
Suffix:
Gender:F
Credentials:GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5719
Mailing Address - Country:US
Mailing Address - Phone:401-415-4212
Mailing Address - Fax:401-415-4348
Practice Address - Street 1:1085 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5719
Practice Address - Country:US
Practice Address - Phone:401-415-4212
Practice Address - Fax:401-415-4348
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP36692363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7008294Medicaid
RI509023739Medicare ID - Type Unspecified
RIP06991Medicare UPIN