Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024173599 | VA |
NPI | 1023469087 |
---|---|
Provider Name | Erin Evans |
First Address | Richmond, VA 23219-1930 |
Second Address | Richmond, VA 23219-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2016 |
Last Update Date | 30/06/2016 |