Provider Demographics
NPI:1447295068
Name:DEKEYSER, EVELYN J (NP)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:J
Last Name:DEKEYSER
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 1:2223 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-4654
Mailing Address - Country:US
Mailing Address - Phone:860-576-3539
Mailing Address - Fax:
Practice Address - Street 1:281 SAWYER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81303-3409
Practice Address - Country:US
Practice Address - Phone:970-259-2162
Practice Address - Fax:940-247-0455
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN-176205363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S46735Medicare UPIN