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Individual

JEAN K EVANGELISTI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
780 LITCHFIELD ST, SUITE 200, TORRINGTON, CT 06790-6268
(860) 489-1984
(860) 496-2195
Mailing address
780 LITCHFIELD ST, SUITE 200, TORRINGTON, CT 06790-6268
(860) 489-1984
(860) 496-2195

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
002284
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004234481
CT
01
400002284CT01
ANTHEM- INSURANCE
DE
01
705146
CONNECTICARE - INSURANCE
CT
Enumeration date
11/15/2005
Last updated
07/23/2010
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