Provider Demographics
NPI:1902310451
Name:EVANS, CAROLYN MAXWELL (PCA)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MAXWELL
Last Name:EVANS
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:MAXWELL
Other - Last Name:BRUNTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1167
Mailing Address - Street 2:
Mailing Address - City:CRAIGSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26205
Mailing Address - Country:US
Mailing Address - Phone:304-742-6260
Mailing Address - Fax:
Practice Address - Street 1:554 RITCHIE FARM ROAD
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651
Practice Address - Country:US
Practice Address - Phone:304-742-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant