Basic Information
| Provider Information | |||||||||
| NPI: | 1184705626 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | DENISE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 161 WASHINGTON STREET | ||||||||
| Address2: | EIGHT TOWER BRIDGE, SUITE 1400 | ||||||||
| City: | CONSHOHOCKEN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4843513200 | ||||||||
| FaxNumber: | 4843513800 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 ELK GROVE TOWN CENTER | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE VILLAGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668253227 | ||||||||
| FaxNumber: | 4843513800 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 209004048 | IL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 209004048 | 01 | IL | LICENSE | OTHER |