Individual
MARY K EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4321 FIR ST, EAST CHICAGO, IN 46312-3049
(219) 765-0597
Mailing address
4321 FIR ST, EAST CHICAGO, IN 46312-3049
(219) 392-7224
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71007197A
IN
Other
Enumeration date
06/22/2017
Last updated
09/10/2018
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