Provider Demographics
NPI:1396804555
Name:EVLOG, CATHERINE (NP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:EVLOG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 CREST AVE
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MA
Mailing Address - Zip Code:02150-2154
Mailing Address - Country:US
Mailing Address - Phone:617-884-5660
Mailing Address - Fax:617-884-1162
Practice Address - Street 1:91 CREST AVE
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MA
Practice Address - Zip Code:02150-2154
Practice Address - Country:US
Practice Address - Phone:617-884-5660
Practice Address - Fax:617-884-1162
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA121377NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS31648Medicare UPIN