Provider Demographics
NPI:1770586398
Name:OUELLETTE, EVELYN (CRNP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:OUELLETTE
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 1:117 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SALAMANCA
Mailing Address - State:NY
Mailing Address - Zip Code:14779-1529
Mailing Address - Country:US
Mailing Address - Phone:716-945-5500
Mailing Address - Fax:716-945-5506
Practice Address - Street 1:117 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALAMANCA
Practice Address - State:NY
Practice Address - Zip Code:14779-1529
Practice Address - Country:US
Practice Address - Phone:716-945-5500
Practice Address - Fax:716-945-5506
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF334898-01363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02946110Medicaid
CT004239770Medicaid
NYJ400014184Medicare PIN
CTQ03898Medicare UPIN
CT500001173Medicare ID - Type Unspecified
NY02946110Medicaid
CT004239770Medicaid