Evelyn Addo-Wallace, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

F421131-1 Issued in NY

Practice address

165 Broadway FL 23
New York, NY 10006-1452

Phone

(888) 731-8994

NPI assigned

Mar 12, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727740800000",
    "number": "1184965493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 REGAL OAK DR",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208521048",
            "telephone_number": "917-297-1980",
            "fax_number": "336-900-1320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "165 BROADWAY FL 23",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100061452",
            "telephone_number": "888-731-8994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10440 Little Patuxent Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210443648",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 N Orange Ave Ste 800",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328012381",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Pennsylvania Ave NW Bldg Suite900",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200042601",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDO-WALLACE",
        "first_name": "EVELYN",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-12",
        "last_updated": "2024-10-01",
        "certification_date": "2024-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "NY",
            "license": "F421131-1",
            "primary": true
        },
        {
            "code": "163WW0101X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Women's Health Care, Ambulatory",
            "state": "NY",
            "license": "659682-1",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00695941",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Beverly Addison, MHC-LP
• Meagen Addison
• Nancy Elizabeth Addison, RD, CDN, CDCES
• Tessa Addison, LCSW
• Victoria Addo-Donkor
• Steven O Addo-Yobo, MD, PHD
• Afua Owusua Addo, MS
• Alex Johnson Addo, MD
• Emilia Addo, MSN RNC APRN BC FNP
• Devon Kimberly Addonizio, MD

• Women's Health Nurse Practitioner in New York, NY
• Providers in New York, NY by specialty
• Women's Health Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.