Individual
GEORGIANA EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Mailing address
1 LONG WHARF DR, STE. 321, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
Primary
41652
CT
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
41652
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004041000
—
CT
05
—
004082260
—
CT
05
—
004082286
—
CT
05
—
008003745
—
CT
05
—
008022622
—
CT
05
—
008022626
—
CT
Enumeration date
11/27/2013
Last updated
11/27/2013
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