Provider Demographics
NPI:1184371379
Name:MCEVOY, THERESA BELL (CRNP)
Entity type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:BELL
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-4219
Mailing Address - Country:US
Mailing Address - Phone:610-731-7994
Mailing Address - Fax:
Practice Address - Street 1:1088 W BALTIMORE PIKE STE 2205
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5136
Practice Address - Country:US
Practice Address - Phone:610-744-2960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP025210363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health