Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036-115952 | IL |
NPI | 1184631715 |
---|---|
Provider Name | Dr. Wayne Evans |
First Address | Milwaukee, WI 53278-8866 |
Second Address | Rockford, IL 61104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 19/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E03368 | (02) | IL |