Provider Demographics
NPI:1104925999
Name:EVANS, GERRI A (RN,MSN,CNM)
Entity type:Individual
Prefix:
First Name:GERRI
Middle Name:A
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN,MSN,CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 QUINCY AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1739
Mailing Address - Country:US
Mailing Address - Phone:570-961-0851
Mailing Address - Fax:570-344-4285
Practice Address - Street 1:748 QUINCY AVE
Practice Address - Street 2:STE 2A
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1739
Practice Address - Country:US
Practice Address - Phone:570-961-0851
Practice Address - Fax:570-344-4285
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMW008591L367A00000X
PARN323049L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001815763Medicaid
PA001815763Medicaid
PA042197Medicare PIN