1790996874 NPI number — MRS. CAROLINE CURTIS EVANS FNP

Table of content: MRS. CAROLINE CURTIS EVANS FNP (NPI 1790996874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790996874 NPI number — MRS. CAROLINE CURTIS EVANS FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
CAROLINE
Provider Middle Name:
CURTIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CURTIS
Provider Other First Name:
CAROLINE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1790996874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST CORINTH
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05040-0900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-439-5321
Provider Business Mailing Address Fax Number:
802-439-6783

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 VILLAGE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
E CORINTH
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-439-5321
Provider Business Practice Location Address Fax Number:
802-439-6783
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  101-36463 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1013811 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".




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