Individual
MRS. MARY JANE EVANGELISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD,DNP,PMHNP
Contact information
Practice address
3900 N PINE GROVE AVE APT 414, CHICAGO, IL 60613-6641
(131) 291-2344
Mailing address
3900 N PINE GROVE AVE APT 414, CHICAGO, IL 60613-6641
(131) 291-2344
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
209.027735
IL
Other
Enumeration date
08/04/2023
Last updated
09/26/2023
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