Individual
EVELYN ADDO-WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
165 BROADWAY FL 23, NEW YORK, NY 10006-1452
(888) 731-8994
Mailing address
1112 REGAL OAK DR, ROCKVILLE, MD 20852-1048
(917) 297-1980
(336) 900-1320
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
659682-1
NY
363LW0102X
Women's Health Nurse Practitioner
Primary
F421131-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00695941
—
NY
Enumeration date
03/12/2013
Last updated
10/01/2024
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