Individual
NICOLE EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1555 LONG POND RD, ROCHESTER, NY 14626-4122
(585) 723-7075
Mailing address
1555 LONG POND RD, ROCHESTER, NY 14626-4122
(585) 723-7075
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
013642
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03252004
—
NY
Enumeration date
07/23/2009
Last updated
12/06/2018
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