Provider Demographics
NPI:1548536675
Name:DANA-EVANS, CARRIE A (CRNP)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:A
Last Name:DANA-EVANS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:A
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6934 AVIATION BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-2593
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6934 AVIATION BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2593
Practice Address - Country:US
Practice Address - Phone:703-389-9833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR184152363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health