Provider Demographics
NPI:1447563937
Name:EVANS, ALYSON M (RN, CNP)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:M
Last Name:EVANS
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21351
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-0351
Mailing Address - Country:US
Mailing Address - Phone:614-338-9158
Mailing Address - Fax:614-569-2257
Practice Address - Street 1:3924 MOUNTVIEW RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-4806
Practice Address - Country:US
Practice Address - Phone:614-338-9158
Practice Address - Fax:614-459-8630
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.11623-NS364SA2200X
OHRN.334971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3087976Medicaid
OHNS04811Medicare UPIN