Individual
MRS. KELLY LORRAINE EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1540 GLENWOOD AVE, SYRACUSE, NY 13207-1011
(315) 476-1771
Mailing address
105 RUSKIN AVE, SYRACUSE, NY 13207-1324
(315) 479-7983
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
Primary
495840-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02701884
—
NY
Enumeration date
09/14/2008
Last updated
09/14/2008
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