Provider Demographics
NPI:1447451596
Name:PEDERSEN, EVELYN LOUISE (N P)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:LOUISE
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 MIDDLE GIBBS RD
Mailing Address - Street 2:
Mailing Address - City:KNOTTS ISLAND
Mailing Address - State:NC
Mailing Address - Zip Code:27950-9749
Mailing Address - Country:US
Mailing Address - Phone:252-435-6489
Mailing Address - Fax:252-435-6489
Practice Address - Street 1:281 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 326
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-2986
Practice Address - Country:US
Practice Address - Phone:757-490-0377
Practice Address - Fax:757-490-1327
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024111409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily