Provider Demographics
NPI:1780076935
Name:PARE, EVANS (LPN)
Entity type:Individual
Prefix:MR
First Name:EVANS
Middle Name:
Last Name:PARE
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1632 HUTCHINSON RIVER PKWY
Mailing Address - Street 2:APT. 3B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-4300
Mailing Address - Country:US
Mailing Address - Phone:347-851-1725
Mailing Address - Fax:
Practice Address - Street 1:1632 HUTCHINSON RIVER PKWY
Practice Address - Street 2:APT. 3B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-4300
Practice Address - Country:US
Practice Address - Phone:347-851-1725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317989-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse