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OrganizationMedicare enrolled
Evergreen Clinic LLC
Nurse Practitioner · Philadelphia, PA
Source: NPPES NPI RegistryFetched 2026-10-20
Public record
- NPI
- 1000001165
- Enumeration date
- 2014-05-13
- Last updated
- 2026-02-23
- Practice location
- 8361 Oak AvePhiladelphia, PA 19103
- Taxonomies
- Nurse Practitioner363L00000XPrimary
- Clinical Medical Laboratory291U00000X
- Website
- Not listed
- Medicare
- Enrolled