Provider Demographics
NPI:1528632619
Name:JOSEPH, EVELYNE
Entity type:Individual
Prefix:
First Name:EVELYNE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:EVELYNE
Other - Middle Name:
Other - Last Name:GUERRIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:7 SHERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:10930-2837
Mailing Address - Country:US
Mailing Address - Phone:845-461-5429
Mailing Address - Fax:
Practice Address - Street 1:7 SHERWOOD CT
Practice Address - Street 2:
Practice Address - City:HIGHLAND MILLS
Practice Address - State:NY
Practice Address - Zip Code:10930-2837
Practice Address - Country:US
Practice Address - Phone:845-461-5429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF01210897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY840193356OtherNEW YORK STATE DRIVER'S LICENSE